Lakewood Family Dental of Anderson

Primary specialty

DentistTaxonomy code 122300000X

License

12012121A Issued in IN

Legal business name

LAKEWOOD FAMILY DENTAL OF ANDERSON

Practice address

1537 S Scatterfield Rd
Suite a
Anderson, IN 46016-5783

Phone

(732) 379-0953

NPI assigned

Oct 17, 2016

Organization subpart

No

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

Authorized official

Name

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 (past) Authorized official

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1215488036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1537 S SCATTERFIELD RD",
            "address_2": "SUITE A",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460165783",
            "telephone_number": "732-379-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1537 S SCATTERFIELD RD",
            "address_2": "SUITE A",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460165783",
            "telephone_number": "732-379-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD FAMILY DENTAL OF ANDERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "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_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012121A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terrie Kutschera, O.T.R.
• Terri L Kyle, WHNP
• Terry Kyle, MD
• Lafayette Township
• Dana Lakes, SPEACH THERAPIST
• Chad C. Lamb, M.D.
• Mackenzie Lamb, RBT
• Payton Lamb, FNP-C
• Samantha Lamb
• Jessica Lee Lambert Moore, O.D.

• Dentist in Anderson, IN
• Providers in Anderson, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; 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.