Organization
KAPIL KELLA DDS PC
Active
Other names
Lakeshore Dental Studio
Organization subpart
No
Provider details
NPI number
Authorized official
KAPIL KELLA DDS (DENTIST/OWNER)
(989) 714-3142
Entity
Organization
Contact information
Practice address
5505 N CLARK ST, CHICAGO, IL 60640-1213
(989) 714-3142
Mailing address
1630 CHICAGO AVE APT 1302, EVANSTON, IL 60201-4593
(989) 714-3142
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.029212
IL
Other
Enumeration date
04/01/2018
Last updated
04/01/2018
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