Provider Demographics
NPI:1740362243
Name:BAKOS, LESTER H (DDS)
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:H
Last Name:BAKOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1587
Mailing Address - Country:US
Mailing Address - Phone:304-293-2240
Mailing Address - Fax:304-293-7646
Practice Address - Street 1:1 MED CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-2240
Practice Address - Fax:304-293-7646
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVU02769Medicare UPIN