John F Lake, DDS
Dentist, General Practice in Ontario, OR. Individual provider (NPI-1).
NPI number1619081031
StatusActive
Last updated in NPPESFeb 10, 2016
Details
- NPI
- 1619081031
- Entity type
- Individual (NPI-1)
- Name
- John F Lake
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 19, 2006
- Last updated
- Feb 10, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 7733 | OR | Yes |
Practice location
286 Sw 4th StOntario, OR 97914-2610
Phone 541-889-7050 · Fax 541-889-6495
Mailing address
286 Sw 4th StOntario, OR 97914-2610
Phone 541-889-7050 · Fax 541-889-6495
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