NPIMap

Organization Active NPI

Lake Dentistry LLC

  • Dentist
  • St Matthews, SC
National Provider Identifier
1699959528
Registry record updated Dec 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
02808 Issued in SC
Legal business name
LAKE DENTISTRY LLC
Practice address
735 Harry C. Raysor Drive
St. Matthews, SC 29135-0237
Phone
(803) 874-2243
NPI assigned
Dec 27, 2007
Last updated
Dec 27, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2007

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

Authorized official

Name
Dr. Clarence Roberts Lake, DMDNPI 1336197201
Title
Owner
Phone
(803) 874-2243

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 02808 SC Primary

Addresses

Primary practice location

735 Harry C. Raysor Drive
St. Matthews, SC 29135-0237

Mailing address

735 Harry C. Raysor Drive
P.O. Box 237
St. Matthews, SC 29135-0237
Phone (803) 874-2243

National Provider Directory

National Provider Directory
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.

Locations

735 Harry C Raysor Dr
St Matthews, SC 29135
Phone (803) 874-2243

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198713600000",
    "number": "1699959528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 HARRY C. RAYSOR DRIVE",
            "address_2": "P.O. BOX 237",
            "city": "ST. MATTHEWS",
            "state": "SC",
            "postal_code": "291350237",
            "telephone_number": "803-874-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 HARRY C. RAYSOR DRIVE",
            "city": "ST. MATTHEWS",
            "state": "SC",
            "postal_code": "291350237",
            "telephone_number": "803-874-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2007-12-27",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "ROBERTS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-874-2243",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "02808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Matthews, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; 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.