Organization
LAKE DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARENCE R LAKE DMD (PARTNER)
(803) 874-2243
Entity
Organization
Contact information
Practice address
735 RAYSOR DRIVE, ST. MATTHEWS, SC 29135
(803) 874-2243
Mailing address
735 RAYSOR DRIVE, ST. MATTHEWS, SC 29135
(803) 874-2243
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9868
—
SC
Enumeration date
12/26/2006
Last updated
01/10/2008
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