Srinivasulu Kakollu, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

019028401 Issued in IL

Practice address

1407 N Veterans Pkwy Ste 12
Bloomington, IL 61704-6425

Phone

(732) 379-0953

NPI assigned

Jul 8, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakewood Family Dental of Indianapolis LLC

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1194213207
  NPD Authorized official
• Lakewood Family Dental of Kokomo PLLC

  • General Practice Dentistry
  • Kokomo, IN
  • NPI 1346738556
  NPD Authorized official
• Lakewood Family Dental

  • General Practice Dentistry
  • Bloomington, IL
  • NPI 1154675304
  NPD (past) Authorized official
• Lakewood Family Dental Inc

  • Dentist
  • Fort Wayne, IN
  • NPI 1386062768
  NPD (past) Authorized official
• Lakewood Family Dental of Anderson

  • Dentist
  • Anderson, IN
  • NPI 1215488036
  NPD (past) Authorized official
• Lakewood Family Dental of Carmel LLC

  • General Practice Dentistry
  • Carmel, IN
  • NPI 1588168876
  NPD (past) Authorized official

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362960000000",
    "number": "1265744189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 N VETERANS PKWY STE 12",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046425",
            "telephone_number": "732-379-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 N VETERANS PKWY STE 12",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046425",
            "telephone_number": "732-379-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKOLLU",
        "first_name": "SRINIVASULU",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2013-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Kaase
• Kabir Center for Health & Rehabilitation, LTD
• Amyas Ahmed Kabir, D.C.
• Arthur Hannington Kabuye, M.D
• Michael Patrick Kahwaji, PSYD
• Sunanda R Kale, APN
• Noah Kalmes, RBT
• Andrea Michelle Kane, MD
• Michaela R Kane
• Wynn Hugh Kao, M.D., PH.D.

• Dentist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; 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.