Lake Village Dental

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

Legal business name

LAKE VILLAGE DENTAL

Practice address

3261 S US Highway 27 # 441E-1
Fruitland Park, FL 34731-4497

Phone

(352) 314-2729

Fax

(352) 314-9889

NPI assigned

Jan 28, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Vamsi Kallepalli, DMDNPI 1225005259

Title

Dentist

Phone

(352) 314-2729

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, and the practitioner matching its NPPES authorized official.

• Vamsi Kallepalli, DMD

  • Dentist
  • Fruitland Park, FL
  • NPI 1225005259
  NPD Authorized official

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1760073217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3261 S US HIGHWAY 27 # 441E-1",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347314497",
            "telephone_number": "352-314-2729",
            "fax_number": "352-314-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3261 S US HIGHWAY 27 # 441E-1",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347314497",
            "telephone_number": "352-314-2729",
            "fax_number": "352-314-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE VILLAGE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "KALLEPALLI",
        "authorized_official_first_name": "VAMSI",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "352-314-2729",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Jonaitis
• Trenitie Jonaitis
• Romina Jones
• Vamsi Kallepalli, DMD
• KC Transit LLC
• Michelle S. Leclear-Dozier, LCSW
• Cynthia Loben
• Lubis Enterprise LLC
• Tim Harold Lynch, R.PH.
• Tenia Manuel

• Public Health Dentistry in Fruitland Park, FL
• Providers in Fruitland Park, FL by specialty
• Public Health Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; 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.