Provider Demographics
NPI:1528250198
Name:LEMLEY, CARLY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:LYNN
Last Name:LEMLEY
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 1:6260 MID ATLANTIC RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4293
Mailing Address - Country:US
Mailing Address - Phone:304-594-2200
Mailing Address - Fax:304-594-2216
Practice Address - Street 1:6260 MID ATLANTIC RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4293
Practice Address - Country:US
Practice Address - Phone:304-594-2200
Practice Address - Fax:304-594-2216
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV38821223G0001X
FLDN 179381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice