Lakewood Family Dental of Kokomo PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKEWOOD FAMILY DENTAL OF KOKOMO PLLC

Practice address

2302 S Dixon Rd Ste 125
Kokomo, IN 46902-6429

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": "1346738556",
    "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": "2302 S DIXON RD STE 125",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469026429",
            "telephone_number": "732-379-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD FAMILY DENTAL OF KOKOMO PLLC",
        "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": []
}

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• General Practice Dentistry in Kokomo, IN
• Providers in Kokomo, 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.