Individual
DR. TERRY L LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
5001 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1217
(304) 768-5721
(304) 768-6131
Mailing address
5001 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1217
(304) 768-5721
(304) 768-6131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2379WV
WV
Other
Enumeration date
06/27/2005
Last updated
07/08/2007
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