Provider Demographics
NPI:1710422209
Name:LAK DDS LLC
Entity Type:Organization
Organization Name:LAK DDS LLC
Other - Org Name:SMILECENTRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUKHALAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-375-5306
Mailing Address - Street 1:14560 RIVER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-5802
Mailing Address - Country:US
Mailing Address - Phone:317-764-2938
Mailing Address - Fax:317-219-6781
Practice Address - Street 1:14560 RIVER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-5801
Practice Address - Country:US
Practice Address - Phone:317-764-2938
Practice Address - Fax:317-219-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120116601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty