Dr. Edward William Lake, DDS
Dentist in Potosi, MO. Individual provider (NPI-1).
NPI number1790820587
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1790820587
- Entity type
- Individual (NPI-1)
- Name
- Dr. Edward William Lake
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 20, 2007
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 11627 | MO | Yes |
Practice location
313 E High StPotosi, MO 63664-1924
Phone 573-438-6277
Mailing address
313 E High StPotosi, MO 63664-1924
Phone 573-438-6277
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