Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1659907871 Individual Practitioner Male Practitioner

Jake Kuruvilla Philip

Dentist - General Practice • Dallas, TX

Professional Overview & Biography Verified Profile Summary

Jake Philip is a registered healthcare professional specializing in Dentist - General Practice in Dallas, TX. Practice services are available at 4500 S LANCASTER RD under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4500 S Lancaster Rd

Dallas, TX 752167167

Telephone 2148571082
Associated Practice Facility / Clinic
🏢 Dallas Vamc Facility NPI 1174572416

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Dallas, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 15.7 Yrs
State Avg: 12.3 Yrs
Regional Practice Density
749 Specialists

Practicing in Dallas, TX (10570 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2020-08-03
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License IL 019.032813

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.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

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.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Dental Licensure
019.032813 (IL)

Secondary Practice Locations

1801 W Wisconsin Ave

Milwaukee, WI 532332186

Phone: 4142886790

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

11 Associated Practitioners
Dr. Guillermo Guillen , DDS

Dentist - Prosthodontics

NPI 1346357738

Doctor of Dental Surgery

Dr. Brett Glasgow , DDS

Dentist - General Practice

NPI 1437160553

Doctor of Dental Surgery

Dr. William Currie , DDS

Dentist - General Practice

NPI 1558452227

Doctor of Dental Surgery

Dr. Aisha George , DDS

Dentist - General Practice

NPI 1578865218

Doctor of Dental Surgery

Dr. Victor Glenn , DDS

Dentist - General Practice

NPI 1649282583

Doctor of Dental Surgery

Dr. Juan Banks , DDS

Dentist - General Practice

NPI 1649282963

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location August 03, 2020

Registered at 4500 S LANCASTER RD, DALLAS, TX 752167167 (Tel: 2148571082)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 03, 2020

Dentist (License #019.032813 in IL)

NPI Profile Active March 19, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location March 19, 2020

Registered at 1801 W WISCONSIN AVE, MILWAUKEE, WI 532332186 (Tel: 4142886790)

📍
Updated Business Mailing Address March 19, 2020

Registered at 3151 GLENWAY DR, NORTHBROOK, IL 600627507 (Tel: 8476249237)

👤
Provider Name / Credentials Updated March 19, 2020

Recorded as JAKE PHILIP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 19, 2020

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration March 19, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1659907871
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 19, 2020
Last Update: August 03, 2020
Sole Proprietor: No

Mailing Address

3151 Glenway Dr

Northbrook, IL 600627507

Phone: 8476249237

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.