MEDICARE: JUDI KAAKARLI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901601375	MI

General Provider Information

NPI Number	:	1083335749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDI KAAKARLI DDS

Provider Business Mailing Address
First Line	:	2700 HAMLIN BLVD
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2206
Country	:	US
Telephone Number	:	313-561-5100
Fax Number	:	313-565-0309

Provider Business Practice Location Address
First Line	:	25650 OUTER DR
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2096
Country	:	US
Telephone Number	:	313-561-5100
Fax Number	:	313-565-0309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	05/07/2026

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