Dr Clarence Roberts Lake, DMD is a medicare enrolled "Dentist - General Practice" provider in St. Matthews, South Carolina. His current practice location is
735 Raysor Drive, St. Matthews, South Carolina. You can reach out to his office (for appointments etc.) via phone at
(803) 874-2243.
Dr Clarence Roberts Lake is licensed to practice in South Carolina (license number 02808) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1336197201.
Healthcare Provider's Profile
Full Name | Dr Clarence Roberts Lake |
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Gender | Male |
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Speciality | Dentist - General Practice |
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Location | 735 Raysor Drive, St. Matthews, South Carolina |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1336197201
- Provider Enumeration Date: 05/04/2006
- Last Update Date: 07/09/2007
Medicare PECOS Information:
- PECOS PAC ID: 4486959665
- Enrollment ID: I20160225001836
Medical Identifiers
Medical identifiers for Dr Clarence Roberts Lake such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1336197201 | NPI | - | NPPES |
Z28088 | Medicaid | SC | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
1223G0001X | Dentist - General Practice | 02808 (South Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Clarence Roberts Lake is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Clarence Roberts Lake, DMD 735 Raysor Drive, St. Matthews, SC 29135-0237 Ph: (803) 874-2243 | Dr Clarence Roberts Lake, DMD 735 Raysor Drive, St. Matthews, SC 29135-0237 Ph: (803) 874-2243 |
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