Dr Clarence Roberts Lake, DMD is a
Dentist - General Practice based in St. Matthews, South Carolina. Dr Clarence Roberts Lake is licensed to practice in South Carolina (license number 02808) and his current practice location is
735 Raysor Drive, St. Matthews, South Carolina. He can be reached at his office (for appointments etc.) via phone at
(803) 874-2243.
NPI number for Dr Clarence Roberts Lake is 1336197201 and his current mailing address is 735 Raysor Drive, St. Matthews, South Carolina. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1336197201.
Healthcare Provider's Profile
| Full Name | Dr Clarence Roberts Lake |
|---|
| Gender | Male |
|---|
| Speciality | Dentist - General Practice |
|---|
| Location | 735 Raysor Drive, St. Matthews, South Carolina |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
NPI Data:
- NPI Number: 1336197201
- Provider Enumeration Date: 05/04/2006
- Last Update Date: 07/09/2007
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
NOT enrolled with medicare and thus cannot 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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