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FUNDAMENTAL DENTAL
NPI 1861094518
Dentist - General Practice in Dallas, TX

Active since November 09, 2020
11613 N CENTRAL EXPY STE 111A, DALLAS, TX 75243(972) 360-0096 Get Directions Write a Review

NPPES record last updated: November 9, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Fundamental Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FUNDAMENTAL DENTAL (NPI 1861094518) is a healthcare organization registered as a general practice in Dallas, Texas and active in the NPI registry since November 2020. The organization lists Jacob Jose Kruvilla, Owner/doctor, as its authorized official.

NPPES Registry Identity

NPI1861094518
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameJACOB K KRUVILLA
Location Address11613 N CENTRAL EXPY STE 111ADallas, TX 75243-3808
Mailing Address11613 N Central Expy Ste 111aDallas, TX 75243-3808 · (972) 360-0096
Phone(972) 360-0096
Organization SubpartNo
Authorized OfficialJacob Jose KruvillaOwner/doctor · (972) 360-0096
Enumeration DateNovember 9, 2020
NPPES CertifiedNovember 9, 2020
✔ NPI 1861094518 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
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.
11613 N CENTRAL EXPY STE 111A, Dallas, TX 75243
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Other Names 1

Doing Business AsFundamental Dental

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MCITY DENTAL PLLC
Dentist (General Practice)
11613 N CENTRAL EXPY STE 111A
DALLAS, TX 75243
Dallas County (469) 450-4543

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob K Kruvilla's NPI number?

The NPI number for Jacob K Kruvilla is 1861094518. It was assigned to this organization in the NPPES registry on November 9, 2020. The provider is doing business as Fundamental Dental.

Where is Jacob K Kruvilla located?

Jacob K Kruvilla is located at 11613 N Central Expy Ste 111A, Dallas, TX 75243. The listed phone number is (972) 360-0096.

What is Jacob K Kruvilla's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Jacob K Kruvilla was last updated on November 9, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.