MEDICARE: DR. LOKESH KUMAR DAMODARAN 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	1223D0001X	Public Health Dentistry	019031083	IL

General Provider Information

NPI Number	:	1659800316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOKESH KUMAR DAMODARAN DDS

Provider Business Mailing Address
First Line	:	24920 MOUND ST
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92350-0202
Country	:	US
Telephone Number	:	424-283-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2937 IL 178
Second Line	:
City	:	NORTH UTICA
State	:	IL
Zip	:	61373
Country	:	US
Telephone Number	:	815-993-3101
Fax Number	:

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

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	06/07/2017

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