Lakewood Family Dental
NPI 1154675304ActiveOrganization· Dentist, General Practice· Bloomington, IL
Dentist, General Practice in Bloomington, Illinois, registered in NPPES in November 2012. The authorized official on file is Srinivasulu Kakollu, DDS, President.
Overview
| NPI | 1154675304 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 8, 2012 |
| Last updated in NPPES | Nov 8, 2012 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | 019-028401 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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