Individual
DR. JOHN ROGER LAKE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1322 MAIN ST, OSTERVILLE, MA 02655-1542
(508) 428-4929
Mailing address
1322 MAIN ST, OSTERVILLE, MA 02655-1542
(508) 428-4929
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14541
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000X06356
BLUE CROSS BLUE SHIELD
MA
Enumeration date
07/12/2006
Last updated
05/26/2015
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