Provider Demographics
NPI:1407152952
Name:LAKE AND LEMERY, PLLC
Entity Type:Organization
Organization Name:LAKE AND LEMERY, PLLC
Other - Org Name:OVERLAKE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-641-4200
Mailing Address - Street 1:14420 BEL RED RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3930
Mailing Address - Country:US
Mailing Address - Phone:425-641-4200
Mailing Address - Fax:425-641-4418
Practice Address - Street 1:14420 BEL RED RD STE 105
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3930
Practice Address - Country:US
Practice Address - Phone:425-641-4200
Practice Address - Fax:425-641-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6030660821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty