# VALERIE E LAKE, DDS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053062430
- **Authorized official:** DR. VALERIE E LAKE DDS (MEMBER)
- **Authorized official phone:** (260) 432-1579

## Contact information

- **Practice address:** 6211 COVINGTON RD, FORT WAYNE, IN 46804-7311
- **Practice address phone:** (260) 432-1579
- **Practice address fax:** (260) 432-4540
- **Mailing address:** 6211 COVINGTON RD, FORT WAYNE, IN 46804-7311
- **Mailing address phone:** (260) 432-1579
- **Mailing address fax:** (260) 432-4540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 01/17/2022
- **Last updated:** 03/08/2022