# EDWARD WILLIAM LAKE DDS PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1063676369
- **Authorized official:** DR. EDWARD WILLIAM LAKE DDS (PRESIDENT)
- **Authorized official phone:** (573) 438-6277

## Contact information

- **Practice address:** 313 E HIGH ST, POTOSI, MO 63664-1924
- **Practice address phone:** (573) 438-6277
- **Mailing address:** 313 E HIGH ST, POTOSI, MO 63664-1924
- **Mailing address phone:** (573) 438-6277

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 11627 | MO | Yes |

## Other

- **Enumeration date:** 07/16/2008
- **Last updated:** 07/16/2008