# LAKEWOOD FAMILY DENTAL OF ANDERSON

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215488036
- **Authorized official:** SRINIVASULU KAKOLLU DDS (PRESIDENT)
- **Authorized official phone:** (732) 379-0953

## Contact information

- **Practice address:** 1537 S SCATTERFIELD RD, SUITE A, ANDERSON, IN 46016-5783
- **Practice address phone:** (732) 379-0953
- **Mailing address:** 1537 S SCATTERFIELD RD, SUITE A, ANDERSON, IN 46016-5783
- **Mailing address phone:** (732) 379-0953

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12012121A | IN | Yes |

## Other

- **Enumeration date:** 10/17/2016
- **Last updated:** 10/17/2016