Provider Demographics
NPI:1124656491
Name:BAKOS, LAUREN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:BAKOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 WOODLAND BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9402
Mailing Address - Country:US
Mailing Address - Phone:304-906-1544
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF ORAL SURGERY ROOM 1200 HSC NORTH
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-2841
Practice Address - Fax:304-293-3674
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice