Basic Information
| Provider Information | |||||||||
| NPI: | 1275715443 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKIREDDY DENTAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 281 SANDERS CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130571307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154546000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7408 BROADVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441345718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167419999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2007 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | LAKRIEDDY | ||||||||
| AuthorizedOfficialFirstName: | MURALI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3154546000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 30-022486 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.