| Cordell Lake, D.d.s., Llc | |
|
12 E Harrison St Farmington MO 63640-1859 | |
| (573) 756-4344 | |
| Not Available |
| Full Name | Cordell Lake, D.d.s., Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12 E Harrison St, Farmington, Missouri |
| Authorized Official Name and Position | Cordell Lake (GENERAL DENTIST) |
| Authorized Official Contact | 8167281630 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cordell Lake, D.d.s., Llc 3145 Cross Creek Dr Camdenton MO 65020-9377 Ph: (816) 728-1630 | Cordell Lake, D.d.s., Llc 12 E Harrison St Farmington MO 63640-1859 Ph: (573) 756-4344 |
| NPI Number | 1619446077 |
|---|---|
| Provider Enumeration Date | 11/15/2018 |
| Last Update Date | 11/15/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619446077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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