Provider Demographics
NPI:1992128714
Name:WAKADE, LAKSHMI (DDS)
Entity type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:
Last Name:WAKADE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2311
Mailing Address - Country:US
Mailing Address - Phone:630-541-3119
Mailing Address - Fax:630-324-6361
Practice Address - Street 1:3213 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3553
Practice Address - Country:US
Practice Address - Phone:248-629-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0296521223G0001X, 1223G0001X
MI29010210971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice