Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lakewood Family Dental

Organization General Practice Dentistry · NPI 1154675304

Lakewood Family Dental is a General Practice Dentistry in Bloomington, Illinois. Licensed in Illinois. Registered with an NPI since 2012.

Licensed in
IL
In the registry since
2012

Practice location Address checks out

1407 N Veterans Pkwy Ste 12
Bloomington, IL 61704-6630
Phone: (732) 379-0953
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 019-028401 (IL)

Record details

NPI number1154675304
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Srinivasulu Kakollu — President · (732) 379-0953
NPI enumeratedNovember 8, 2012
Last updated in NPPESNovember 8, 2012
Mailing address1407 N Veterans Pkwy, Suite 12, Bloomington, IL 61704-6630

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