Individual
DR. KEVIN JOSEPH LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5 ETHAN DR, NEW PROVIDENCE, NJ 07974-1604
(908) 464-5270
Mailing address
5 ETHAN DR, NEW PROVIDENCE, NJ 07974-1604
(908) 464-5270
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI02044100
NJ
Other
Enumeration date
07/27/2006
Last updated
07/08/2007
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