| Lake Dentistry Llc | |
|
735 Harry C. Raysor Drive St. Matthews SC 29135-0237 | |
| (803) 874-2243 | |
| Not Available |
| Full Name | Lake Dentistry Llc |
|---|---|
| Speciality | Dentist |
| Location | 735 Harry C. Raysor Drive, St. Matthews, South Carolina |
| Authorized Official Name and Position | Clarence Roberts Lake (OWNER) |
| Authorized Official Contact | 8038742243 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Dentistry Llc 735 Harry C. Raysor Drive P.o. Box 237 St. Matthews SC 29135-0237 Ph: (803) 874-2243 | Lake Dentistry Llc 735 Harry C. Raysor Drive St. Matthews SC 29135-0237 Ph: (803) 874-2243 |
| NPI Number | 1699959528 |
|---|---|
| Provider Enumeration Date | 12/27/2007 |
| Last Update Date | 12/27/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699959528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 02808 (South Carolina) | Primary |
Lake Dentistry, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 735 Raysor Drive, St. Matthews, SC 29135 Phone: 803-874-2243 |