Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Lakewood Family Dental Inc

Organization Dentist · NPI 1386062768

Lakewood Family Dental Inc provides Dentist services in Fort Wayne, Indiana. Licensed in Illinois. Registered with an NPI since 2014.

Licensed in
IL
In the registry since
2014
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4512 Parnell Ave
Fort Wayne, IN 46825-5836 Not confirmed with CMS for 12 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

Dentist (primary) Taxonomy 122300000X · Licence 019028401 (IL)

Record details

NPI number1386062768
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Srinivasulu Kakollu — President · (732) 379-0953
NPI enumeratedApril 2, 2014
Last updated in NPPESApril 3, 2014
Mailing address1407 N Veterans Pkwy, Suite 12, Bloomington, IL 61704-6630

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