Provider Demographics
NPI:1932843331
Name:LAKOTA, CLEOPATRA ZOFIA
Entity type:Individual
Prefix:
First Name:CLEOPATRA
Middle Name:ZOFIA
Last Name:LAKOTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DAVENPORT ST UNIT 315
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2130
Mailing Address - Country:US
Mailing Address - Phone:718-213-6674
Mailing Address - Fax:
Practice Address - Street 1:1630 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-2056
Practice Address - Country:US
Practice Address - Phone:908-730-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI030277001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program