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General NPI Number Information
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NPI Number | 1275715443
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Entity Type | Organization
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Legal Business Name | LAKIREDDY DENTAL PC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 7408 BROADVIEW RD
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City | CLEVELAND
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State | OH
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Zip | 44134-5718
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Country | US
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Telephone | 216-741-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 281 SANDERS CREEK PKWY
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-1307
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Country | US
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Telephone | 315-454-6000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MURALI LAKRIEDDY
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Credential |
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Telephone | 315-454-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-022486
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License Number State | OH
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