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NPI Code Detail

MEDICARE: DR. MATTHEW JOSEPH LAKE DMD

MEDICARE: DR. MATTHEW JOSEPH LAKE DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry203208CO

General Provider Information

NPI Number : 1063942456
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW JOSEPH LAKE DMD
Provider Business Mailing Address
First Line : 1777 S HARRISON ST STE 1400
Second Line :
City : DENVER
State : CO
Zip : 80210-3937
Country : US
Telephone Number : 303-285-6098
Fax Number :
Provider Business Practice Location Address
First Line : 390 S WILCOX ST STE A
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80104-1951
Country : US
Telephone Number : 303-660-6000
Fax Number : 303-660-9745
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2017
Last Update Date : 06/18/2017

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Directions to “ DR. MATTHEW JOSEPH LAKE DMD” Practice Location

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