Organization
TERRY H HAKE DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY HENRY HAKE DDS (OWNER ENDODONTIST)
(757) 229-4115
Entity
Organization
Contact information
Practice address
1761 JAMESTOWN ROAD, SUITE 102, WILLIAMSBURG, VA 23185
(757) 229-4115
(757) 229-8297
Mailing address
1761 JAMESTOWN ROAD, SUITE 102, WILLIAMSBURG, VA 23185
(757) 229-4115
(757) 229-8297
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
0401008049
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10153
—
VA
01
—
166891
UNITED CONCORDIA
—
01
—
234929
ANTHEM
—
Enumeration date
08/06/2007
Last updated
08/06/2007
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