Individual
DR. JOHN CAMPBELL LAKE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2706 MAIN ST, NEWBERRY, SC 29108-4004
(803) 276-2090
Mailing address
2706 MAIN ST, NEWBERRY, SC 29108-4004
(803) 276-2090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4593
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX4593
—
SC
Enumeration date
10/29/2009
Last updated
04/18/2016
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