Lake Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKE DENTISTRY, LLC

Practice address

735 Raysor Drive
St. Matthews, SC 29135

Phone

(803) 874-2243

NPI assigned

Dec 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clarence R Lake, DMDNPI 1336197201

Title

Partner

Phone

(803) 874-2243

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Lake Dentistry LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lake Dentistry LLC

  • Dentist
  • St. Matthews, SC
  • NPI 1699959528
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clarence Roberts Lake, D.M.D.

  • General Practice Dentistry
  • St. Matthews, SC
  • NPI 1336197201
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1376608992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 RAYSOR DRIVE",
            "city": "ST. MATTHEWS",
            "state": "SC",
            "postal_code": "29135",
            "telephone_number": "803-874-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 RAYSOR DRIVE",
            "city": "ST. MATTHEWS",
            "state": "SC",
            "postal_code": "29135",
            "telephone_number": "803-874-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "803-874-2243",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9868",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kharma Faye Joyner
• Ali Kareem
• Jennifer Reese King, DIRECTOR
• Deborah H Kizer, APRN
• Lake Dentistry LLC
• Clarence Roberts Lake, D.M.D.
• Saundra E Leonard, RN
• Madison Transport LLC
• Michelle L McGill, DC
• Sarah K McLauchlin, PA-C, MPAS

• General Practice Dentistry in St. Matthews, SC
• Providers in St. Matthews, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.