Individual
DR. CORDELL LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12 E HARRISON ST, FARMINGTON, MO 63640-1859
(573) 756-4344
Mailing address
12 E HARRISON ST, FARMINGTON, MO 63640-1859
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2014016814
MO
Other
Enumeration date
06/05/2014
Last updated
03/04/2019
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