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LAKEWOOD FAMILY DENTAL
NPI 1154675304
Dentist - General Practice in Bloomington, IL

Active since November 08, 2012
1407 N VETERANS PKWY, SUITE 12, BLOOMINGTON, IL 61704(732) 379-0953 Get Directions Write a Review

NPPES record last updated: November 8, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Lakewood Family Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKEWOOD FAMILY DENTAL (NPI 1154675304) is a healthcare organization registered as a general practice in Bloomington, Illinois and active in the NPI registry since November 2012. The organization lists Srinivasulu Kakollu, President, as its authorized official.

NPPES Registry Identity

NPI1154675304
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameLAKEWOOD FAMILY DENTAL
Location Address1407 N VETERANS PKWY, SUITE 12Bloomington, IL 61704-6630
Mailing Address1407 N Veterans Pkwy, Suite 12Bloomington, IL 61704-6630 · (732) 379-0953
Phone(732) 379-0953
Organization SubpartNo
Authorized OfficialSrinivasulu KakolluPresident · (732) 379-0953
Enumeration DateNovember 8, 2012
✔ NPI 1154675304 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in IL · 019-028401
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
1407 N VETERANS PKWY, Bloomington, IL 61704
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALYSSA HIGGINS
Dental Hygienist
1407 N VETERANS PKWY, SUITE 12
BLOOMINGTON, IL 61704
McLean County (309) 661-2999
SANDEEP THOTA
Dentist
1407 N VETERANS PKWY
BLOOMINGTON, IL 61704
McLean County (314) 651-6550
DR. ANDY MANCINI DMD, MBA
Dentist (Pediatric Dentistry)
1407 N VETERANS PKWY
BLOOMINGTON, IL 61704
McLean County (309) 661-2999

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakewood Family Dental's NPI number?

The NPI number for Lakewood Family Dental is 1154675304. It was assigned to this organization in the NPPES registry on November 8, 2012.

Where is Lakewood Family Dental located?

Lakewood Family Dental is located at 1407 N Veterans Pkwy Suite 12, Bloomington, IL 61704. The listed phone number is (732) 379-0953.

What is Lakewood Family Dental's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Lakewood Family Dental was last updated on November 8, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.