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

Lakewood Family Dental Inc

Organization Dentist · NPI 1386062768

Lakewood Family Dental Inc is a Dentist in Fort Wayne, Indiana. Licensed in Illinois. Registered with an NPI since 2014.

Licensed in
IL
In the registry since
2014
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4512 Parnell Ave
Fort Wayne, IN 46825-5836
Phone: (732) 379-0953
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 019028401 (IL)

Record details

NPI number1386062768
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Srinivasulu Kakollu — President · (732) 379-0953
NPI enumeratedApril 2, 2014
Last updated in NPPESApril 3, 2014
Mailing address1407 N Veterans Pkwy, Suite 12, Bloomington, IL 61704-6630

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