| Lake Dentistry, Llc | |
|
735 Raysor Drive St. Matthews SC 29135 | |
| (803) 874-2243 | |
| Not Available |
| Full Name | Lake Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 735 Raysor Drive, St. Matthews, South Carolina |
| Authorized Official Name and Position | Clarence R Lake (PARTNER) |
| Authorized Official Contact | 8038742243 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Dentistry, Llc 735 Raysor Drive St. Matthews SC 29135 Ph: (803) 874-2243 | Lake Dentistry, Llc 735 Raysor Drive St. Matthews SC 29135 Ph: (803) 874-2243 |
| NPI Number | 1376608992 |
|---|---|
| Provider Enumeration Date | 12/26/2006 |
| Last Update Date | 01/10/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376608992 | NPI | - | NPPES |
| ZA9868 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (South Carolina) | Primary |
Lake Dentistry Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 735 Harry C. Raysor Drive, St. Matthews, SC 29135 Phone: 803-874-2243 |