Provider Demographics
NPI:1720842412
Name:BILLINGS, DAVID LAKE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LAKE
Last Name:BILLINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 OLD MOCKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-9071
Mailing Address - Country:US
Mailing Address - Phone:704-213-3485
Mailing Address - Fax:
Practice Address - Street 1:5833 PHYLISS LN
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9031
Practice Address - Country:US
Practice Address - Phone:704-568-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC143831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice