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Organization
LAKEWOOD FAMILY DENTAL OF INDIANAPOLIS LLC
Active
Organization
LAKEWOOD FAMILY DENTAL OF INDIANAPOLIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINIVASULU KAKOLLU DDS (PRESIDENT)
(732) 379-0953
Entity
Organization
Contact information
Practice address
3443 W 86TH ST STE C, INDIANAPOLIS, IN 46268-1991
(732) 379-0953
Mailing address
8777 PURDUE RD STE 115, INDIANAPOLIS, IN 46268-3104
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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