Matthew Bryant Lake, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11746 Issued in OR

Practice address

201 SE Washington St Ste B
Dallas, OR 97338-2860

Phone

(503) 623-2666

NPI assigned

Jul 9, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Matthew B Lake, DMD, PC

  dba Lake Family Dental

  • Dental Clinic/Center
  • Eugene, OR
  • NPI 1891669727
  NPD Authorized official
• James Dental Group PC

  dba Dallas Family Dental

  • Dentist
  • Dallas, OR
  • NPI 1396262010
  NPD
• Ryan, James, Wiles, Patel & Olsen LLP

  dba Village Family Dental

  • Dentist
  • Laurinburg, NC
  • NPI 1053795336
  NPD
• Ryan, James, Wiles, Patel & Olsen LLP

  dba Southeastern Dental Specialists

  • Dentist
  • Fayetteville, NC
  • NPI 1346473279
  NPD (past)

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

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1750952750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SE WASHINGTON ST STE B",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382860",
            "telephone_number": "503-623-2666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SE WASHINGTON ST STE B",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382860",
            "telephone_number": "503-623-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MATTHEW",
        "middle_name": "BRYANT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-09",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "12372",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Koens
• Ami Korsunsky, M.A. COUNSELING
• Kimberli Ann Krenik, LPC
• Sloan Krueger
• Allison Lafountain, BA QMHA
• Rebecka Langley
• Sue Larsen, MA, MFT
• Steven A Latulippe, M.D.
• Jacqueline Yvonne Lawson
• Sylvia Joy Lawson, RN

• General Practice Dentistry in Dallas, OR
• Providers in Dallas, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.