Organization
MID-CAROLINA DENTAL CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN CAMPBELL LAKE JR. D.M.D. (GENERAL DENTIST)
(803) 276-2090
Entity
Organization
Contact information
Practice address
316 N WHEELER AVE, PROSPERITY, SC 29127
(803) 364-2726
Mailing address
2706 MAIN ST, NEWBERRY, SC 29108-4004
(803) 276-2090
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4593
SC
Other
Enumeration date
01/20/2017
Last updated
01/20/2017
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