Edward William Lake DDS PC

NPI #1063676369 in Potosi, Missouri

Provider Information

NPI Number: 1063676369
Entity Type: Organization
Organization Name: Edward William Lake DDS PC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Jul 16, 2008
Last Updated: Jul 16, 2008

Practice Location

Address: 313 E HIGH ST
City: Potosi
State: Missouri
ZIP Code: 63664-1924
Phone: (573) 438-6277

Authorized Official

Name: DR. EDWARD WILLIAM LAKE, DDS
Title: PRESIDENT
Phone: (573) 438-6277

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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