Provider Demographics
NPI:1598335689
Name:PANCAKE, ALEX RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:RICHARD
Last Name:PANCAKE
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 1:9000 COOMBS FARM RD STE 304
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1150
Mailing Address - Country:US
Mailing Address - Phone:304-771-1861
Mailing Address - Fax:
Practice Address - Street 1:9000 COOMBS FARM RD STE 304
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1150
Practice Address - Country:US
Practice Address - Phone:304-771-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0445471223E0200X
WV45151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics