Lakewood Family Dental of Indianapolis LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKEWOOD FAMILY DENTAL OF INDIANAPOLIS LLC

Practice address

3443 W 86TH St Ste C
Indianapolis, IN 46268-1991

Phone

(732) 379-0953

NPI assigned

Apr 24, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Srinivasulu Kakollu, DDSNPI 1265744189

Title

President

Phone

(732) 379-0953

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Srinivasulu Kakollu, D.D.S

  • Dentist
  • Bloomington, IL
  • NPI 1265744189
  NPD Authorized official

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524528000000",
    "number": "1194213207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8777 PURDUE RD STE 115",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462683104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3443 W 86TH ST STE C",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462681991",
            "telephone_number": "732-379-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD FAMILY DENTAL OF INDIANAPOLIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-24",
        "last_updated": "2018-04-24",
        "status": "A",
        "authorized_official_last_name": "KAKOLLU",
        "authorized_official_first_name": "SRINIVASULU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-379-0953",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeshore Chiropractic PC
• Lakeside Chiropractic Clinic PC
• Lakeview Manor, Inc.
• Lakeview MRI LLC
• Eshetu Assefa Lakew
• Salman Lakhani, DO
• Richa Lakhotia, M.B.B.S.
• Elana Laks, DMD
• Ulen Laland
• Chandana Lall, MD

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; 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.