Daniel Kuruvilla

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN26484 Issued in FL

Practice address

463725 State Road 200 Ste 3
Yulee, FL 32097-8671

Phone

(904) 584-9004

Fax

(904) 347-2611

NPI assigned

Mar 20, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jacksonville Tongue Tie LLC

  • Pediatric Dentistry
  • Saint Johns, FL
  • NPI 1831858067
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1902482003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ELMWOOD AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146202913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463725 STATE ROAD 200 STE 3",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320978671",
            "telephone_number": "904-584-9004",
            "fax_number": "904-347-2611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "196 Everest Ln Ste 1",
            "address_purpose": "LOCATION",
            "city": "Saint Johns",
            "state": "FL",
            "postal_code": "322594103",
            "country_code": "US",
            "telephone_number": "904-584-9004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KURUVILLA",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-20",
        "last_updated": "2023-09-01",
        "certification_date": "2021-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN26484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Farkhanda Khan, LMHC
• Sandra Denice King
• Brittany M Kinser, OTR/L
• Katrina Kirkland, PTA
• Jason E Kugel, MS, LMHC, NCC
• Cody Marie Lane, AP
• Lashonda
• Lasting Legacy Home Care LLC
• Gabrielle Lawrence
• Allexia Hope Lebarron

• Pediatric Dentistry in Yulee, FL
• Providers in Yulee, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.