Lakewood Family Dental
Lakewood Family Dental provides General Practice Dentistry in Bloomington, Illinois. Licensed in Illinois. Registered with an NPI since 2012.
- Licensed in
- IL
- In the registry since
- 2012
Practice location Address checks out
1407 N Veterans Pkwy Ste 12Bloomington, IL 61704-6630 Not confirmed with CMS for 13 years — call before visiting
Phone: (732) 379-0953
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| General Practice Dentistry (primary) | Taxonomy 1223G0001X · Licence 019-028401 (IL) |
|---|
Record details
| NPI number | 1154675304 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Srinivasulu Kakollu — President · (732) 379-0953 |
| NPI enumerated | November 8, 2012 |
| Last updated in NPPES | November 8, 2012 |
| Mailing address | 1407 N Veterans Pkwy, Suite 12, Bloomington, IL 61704-6630 |
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