Individual
DR. JEREMY BRIAN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
755 SCOTT CIR BLDG 559, JBPHH, HI 96853-5399
(808) 448-6371
Mailing address
724 LELEMANU ALY, HONOLULU, HI 96818-5942
(707) 392-9419
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3792
WV
Other
Enumeration date
09/20/2007
Last updated
08/26/2022
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