Individual
JEFFREY MICHAEL LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
123 S STONE AVE, TUCSON, AZ 85701-1914
(520) 798-3384
(520) 620-1246
Mailing address
123 S STONE AVE, TUCSON, AZ 85701-1914
(520) 798-3384
(520) 620-1246
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D009660
AZ
Other
Enumeration date
02/20/2017
Last updated
02/20/2017
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