Provider Demographics
NPI:1659800316
Name:DAMODARAN, LOKESH KUMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOKESH KUMAR
Middle Name:
Last Name:DAMODARAN
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 1:24920 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0202
Mailing Address - Country:US
Mailing Address - Phone:424-283-0005
Mailing Address - Fax:
Practice Address - Street 1:2937 IL 178
Practice Address - Street 2:
Practice Address - City:NORTH UTICA
Practice Address - State:IL
Practice Address - Zip Code:61373
Practice Address - Country:US
Practice Address - Phone:815-993-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190310831223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health