Organization
LAKE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S LAKE DDS (DENTIST)
(573) 348-9888
Entity
Organization
Contact information
Practice address
1037 PALISADES BLVD STE 9, OSAGE BEACH, MO 65065
(573) 348-9888
(573) 348-9894
Mailing address
1037 PALISADES BLVD STE 9, OSAGE BEACH, MO 65065-3340
(573) 348-9888
(573) 348-9894
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2006014707
MO
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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