Individual
DR. GREGORY ALAN LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.S.
Contact information
Practice address
918 CHESTNUT RIDGE RD, SUITE 5, MORGANTOWN, WV 26505-2822
(304) 598-2500
(304) 598-2517
Mailing address
918 CHESTNUT RIDGE RD, SUITE 5, MORGANTOWN, WV 26505-2822
(304) 598-2500
(304) 598-2517
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2285
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0135456000
—
WV
Enumeration date
11/30/2006
Last updated
07/08/2007
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