OrganizationActive
Lakewood Family Dental
NPI 1154675304 · General Practice Dentistry · Bloomington, IL
Provider details
- NPI number
- 1154675304
- Entity type
- Organization
- Primary specialty
- General Practice DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Srinivasulu Kakollu, President(732) 379-0953
- License
- 019-028401 (IL)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(78/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1407 N Veterans Pkwy
Suite 12
Bloomington, IL 61704-6630
Phone: (732) 379-0953
Street-level locationGet directions
Mailing address
1407 N Veterans Pkwy
Bloomington, IL 61704-6630
Registry dates
- Enumerated
- 2012-11-08
- Last updated
- 2012-11-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.