Provider Demographics
NPI:1609059914
Name:LAKOTA, MICHAEL JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:LAKOTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 W OGDEN AVE
Mailing Address - Street 2:ST 123
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3943
Mailing Address - Country:US
Mailing Address - Phone:630-983-2600
Mailing Address - Fax:630-983-3697
Practice Address - Street 1:1767 W OGDEN AVE
Practice Address - Street 2:ST 123
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3943
Practice Address - Country:US
Practice Address - Phone:630-983-2600
Practice Address - Fax:630-983-3697
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist