NPIMap

Organization Active NPI

Lakewood Family Dental of Lafayette Inc

  • Dentist
  • Lafayette, IN
National Provider Identifier
1487026431
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12012121A Issued in IN
Legal business name
LAKEWOOD FAMILY DENTAL OF LAFAYETTE INC
Practice address
2 Executive Dr
Lafayette, IN 47905-4878
Phone
(765) 807-6666
NPI assigned
Oct 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

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

Authorized official

Name
Srinivasulu Kakollu, DDS
Title
President
Phone
(765) 807-6666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 12012121A IN Primary

Addresses

Primary practice location

2 Executive Dr
Lafayette, IN 47905-4878

Mailing address

2 Executive Dr
Lafayette, IN 47905-4878
Phone (765) 807-6666

National Provider Directory

National Provider Directory

Locations

2 Executive Dr
Lafayette, IN 47905
Phone (270) 935-9001

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1487026431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 EXECUTIVE DR",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054878",
            "telephone_number": "765-807-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 EXECUTIVE DR",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054878",
            "telephone_number": "765-807-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD FAMILY DENTAL OF LAFAYETTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "KAKOLLU",
        "authorized_official_first_name": "SRINIVASULU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-807-6666",
        "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": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.