Provider Demographics
NPI:1891669727
Name:MATTHEW B LAKE, DMD, PC
Entity type:Organization
Organization Name:MATTHEW B LAKE, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-686-1199
Mailing Address - Street 1:721 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6008
Mailing Address - Country:US
Mailing Address - Phone:541-686-1199
Mailing Address - Fax:541-686-3033
Practice Address - Street 1:721 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6008
Practice Address - Country:US
Practice Address - Phone:541-686-1199
Practice Address - Fax:541-686-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service