Organization
LAKEWOOD FAMILY DENTAL OF KOKOMO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINIVASULU KAKOLLU DDS (PRESIDENT)
(732) 379-0953
Entity
Organization
Contact information
Practice address
2302 S DIXON RD STE 125, KOKOMO, IN 46902-6429
(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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