Organization
LAKEWOOD FAMILY DENTAL OF LAFAYETTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVASULU KAKOLLU DDS (PRESIDENT)
(765) 807-6666
Entity
Organization
Contact information
Practice address
2 EXECUTIVE DR, LAFAYETTE, IN 47905-4878
(765) 807-6666
Mailing address
2 EXECUTIVE DR, LAFAYETTE, IN 47905-4878
(765) 807-6666
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012121A
IN
Other
Enumeration date
10/28/2015
Last updated
10/28/2015
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