Organization
LAKE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARENCE ROBERTS LAKE DMD (OWNER)
(803) 874-2243
Entity
Organization
Contact information
Practice address
735 HARRY C. RAYSOR DRIVE, ST. MATTHEWS, SC 29135-0237
(803) 874-2243
Mailing address
735 HARRY C. RAYSOR DRIVE, P.O. BOX 237, ST. MATTHEWS, SC 29135-0237
(803) 874-2243
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
02808
SC
Other
Enumeration date
12/27/2007
Last updated
12/27/2007
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