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Jake Kuruvilla Philip
Student in an Organized Health Care Education/Training Program in Dallas, Texas
NPI 1659907871

Jake Kuruvilla Philip is a Student in an Organized Health Care Education/Training Program based in Northbrook, TX. Jake Kuruvilla Philip practices in Dallas, TX. The NPI Number for Jake Kuruvilla Philip is 1659907871 and holds a License No. 019.032813 (Texas).

The current practice location address for Jake Kuruvilla Philip is 4500 S Lancaster Rd, Dallas, TX and can be reached out via phone at 214-857-1082.

Location: 4500 S Lancaster Rd, Dallas, TX, 60062-7507
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1659907871
Provider Name
Jake Kuruvilla Philip
Credential
Provider Entity Type
Individual
Gender
Male
Address
4500 S Lancaster Rd, Dallas, TX, 60062-7507
Phone Number
214-857-1082
Fax Number
Provider Enumeration Date
03/19/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
019.032813 01 IL DENTAL LICENSURE
institution
Provider Business Practice Location Address Details
Address
4500 S Lancaster Rd
City
Dallas
State
Texas
Zip
75216-7167
Phone Number
214-857-1082
Fax Number
person
Provider Business Mailing Address Details
Address
4500 S Lancaster Rd
City
Dallas
State
Texas
Zip
75216-7167
Phone Number
214-857-1082
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
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Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
019.032813 (Illinois)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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