Edward William Lake, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

11627 Issued in MO

Practice address

313 E High St
Potosi, MO 63664-1924

Phone

(573) 438-6277

NPI assigned

Feb 20, 2007

Sex

Male

Sole proprietor

No

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.

• Edward William Lake DDS PC

  • Dental Clinic/Center
  • Potosi, MO
  • NPI 1063676369
  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790820587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 E HIGH ST",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641924",
            "telephone_number": "573-438-6277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 E HIGH ST",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641924",
            "telephone_number": "573-438-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "EDWARD",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "11627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Juliette
• Angela Kearns
• Shayne S Keddy, D.O.
• Emily Morgan Kelley, CPNP-PC
• Marianne Klemm, D.O.
• Carolyn Coyne Maryan
• Christopher Ryan Massey, MSW, LCSW
• Heather Renee Mathieson, PLPC
• Stephen McKown Matthews, D.D.S.
• Tiara Michele McCarthy

• All providers in Potosi, MO
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.