Provider Demographics
NPI:1588970636
Name:LAKE, JAMES A (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:LAKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:345 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 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
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA59657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist