LAKEWOOD FAMILY DENTAL INC

FORT WAYNE, IN
NPI1386062768
Entity TypeOrganization
Authorized ContactSRINIVASULU KAKOLLU
President
732-379-0953
Organization Subpart ?No
Primary Taxonomy122300000X Dentist
(Licence: IL  019028401)
Enumeration Date2014-04-02
Last Update Date2014-04-03
Business Address
LAKEWOOD FAMILY DENTAL INC
4512 PARNELL AVE
FORT WAYNE, IN 46825-5836
Phone number: 732-379-0953
Mailing Address
LAKEWOOD FAMILY DENTAL INC
1407 N VETERANS PKWY SUITE 12
BLOOMINGTON, IL 61704-6630
Phone number: 732-379-0953
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