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General NPI Number Information
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NPI Number | 1104017060
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Entity Type | Organization
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Legal Business Name | TERRY H HAKE DDS PC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 1761 JAMESTOWN ROAD SUITE 102
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City | WILLIAMSBURG
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State | VA
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Zip | 23185
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Country | US
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Telephone | 757-229-4115
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Fax | 757-229-8297
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Provider Business Mailing Address
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Address Line | 1761 JAMESTOWN ROAD SUITE 102
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City | WILLIAMSBURG
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State | VA
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Zip | 23185
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Country | US
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Telephone | 757-229-4115
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Fax | 757-229-8297
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Authorized Official
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Title or Position | OWNER ENDODONTIST
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Name | TERRY HENRY HAKE
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Credential | DDS
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Telephone | 757-229-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401008049
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License Number State | VA
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