Edward William Lake Dds Pc

NPI 1063676369 - Clinic/Center - 261QD0000X

NPI Details
NPI 1063676369
Enumeration Date 07/16/2008
Last Updated 07/16/2008
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name EDWARD WILLIAM EDWARD
Position PRESIDENT
Phone (573) 438-6277
Fax
Practice Location
313 E HIGH ST
POTOSI MO, 63664-1924, US
Phone (573) 438-6277
Fax
Business Location
313 E HIGH ST
POTOSI MO, 63664-1924, US
Phone (573) 438-6277
Fax
Toxanomy
Taxonomy Code 261QD0000X
License State Missouri
License Number 11627
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According to our database, Edward William Lake Dds Pc NPI is 1063676369, taxonomy code is 261QD0000X and license number is 11627, license state is located at Missouri. Edward William Lake Dds Pc physically located at 313 E High St, Potosi MO, 63664-1924. NPI Number 1033115704 has the healthcare provider type.

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1063676369 NPI number is provided on an as is basis without warranty of any kind. 1063676369 is maintained by the National Plan & Provider Enumeration System. The contents of Edward William Lake Dds Pc are for informational purposes only.