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Organization
EDWARD WILLIAM LAKE DDS PC
Active
Organization
EDWARD WILLIAM LAKE DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD WILLIAM LAKE DDS (PRESIDENT)
(573) 438-6277
Entity
Organization
Contact information
Practice address
313 E HIGH ST, POTOSI, MO 63664-1924
(573) 438-6277
Mailing address
313 E HIGH ST, POTOSI, MO 63664-1924
(573) 438-6277
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11627
MO
Other
Enumeration date
07/16/2008
Last updated
07/16/2008
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