Provider Demographics
NPI:1790154201
Name:JOHN H. LAKE, D.D.S. INC
Entity Type:Organization
Organization Name:JOHN H. LAKE, D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-327-1138
Mailing Address - Street 1:345 E TACHEVAH DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5742
Mailing Address - Country:US
Mailing Address - Phone:760-327-1138
Mailing Address - Fax:760-327-2826
Practice Address - Street 1:345 E TACHEVAH DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5742
Practice Address - Country:US
Practice Address - Phone:760-327-1138
Practice Address - Fax:760-327-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty