Provider Demographics
NPI:1457440224
Name:LIMBAUGH, MATTHEW BLAKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BLAKE
Last Name:LIMBAUGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 COBBLE FARMS DR SE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON COVE
Mailing Address - State:AL
Mailing Address - Zip Code:35763-7009
Mailing Address - Country:US
Mailing Address - Phone:256-551-0304
Mailing Address - Fax:
Practice Address - Street 1:200 BOB WALLACE AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3809
Practice Address - Country:US
Practice Address - Phone:256-539-6634
Practice Address - Fax:256-539-5520
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist