Individual
DR. MATTHEW BRYANT LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
201 SE WASHINGTON ST STE B, DALLAS, OR 97338-2860
(503) 623-2666
Mailing address
201 SE WASHINGTON ST STE B, DALLAS, OR 97338-2860
(503) 623-2666
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12372
NC
1223G0001X
General Practice Dentistry
Primary
D11746
OR
Other
Enumeration date
07/09/2021
Last updated
01/17/2024
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