Lakewood Family Dental
NPI #1154675304 in Bloomington, Illinois
Provider Information
- NPI Number
- 1154675304
- Entity Type
- Organization
- Organization Name
- Lakewood Family Dental
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Nov 8, 2012
- Last Updated
- Nov 8, 2012
Practice Location
- Address
- 1407 N VETERANS PKWY
- Address 2
- SUITE 12
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61704-6630
- Phone
- (732) 379-0953
Authorized Official
- Name
- DR. SRINIVASULU KAKOLLU, DDS
- Title
- PRESIDENT
- Phone
- (732) 379-0953
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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