Edward William Lake Dds Pc | |
313 E High St Potosi MO 63664-1924 | |
(573) 438-6277 | |
Not Available |
Full Name | Edward William Lake Dds Pc |
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Speciality | Clinic/center - Dental |
Location | 313 E High St, Potosi, Missouri |
Authorized Official Name and Position | Edward William Lake (PRESIDENT) |
Authorized Official Contact | 5734386277 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Edward William Lake Dds Pc 313 E High St Potosi MO 63664-1924 Ph: (573) 438-6277 | Edward William Lake Dds Pc 313 E High St Potosi MO 63664-1924 Ph: (573) 438-6277 |
NPI Number | 1063676369 |
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Provider Enumeration Date | 07/16/2008 |
Last Update Date | 07/16/2008 |
Identifier | Type | State | Issuer |
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1063676369 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 11627 (Missouri) | Primary |
Nikodem And Hill Family Dental And Ortho Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Health Way Dr Ste 1, Potosi, MO 63664 Phone: 573-438-2118 |