# R L LAKE DDS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Talihina Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669585402
- **Authorized official:** DR. RAMON L LAKE JR. DDS (PRESIDENT R L LAKE DDS INC)
- **Authorized official phone:** (918) 567-3961

## Contact information

- **Practice address:** 200 DALLAS ST, TALIHINA, OK 74571-2402
- **Practice address phone:** (918) 567-3961
- **Practice address fax:** (918) 567-3424
- **Mailing address:** 200 DALLAS ST, TALIHINA, OK 74571-2402
- **Mailing address phone:** (918) 567-3961
- **Mailing address fax:** (918) 567-3424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4059 | OK | Yes |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 09/19/2007