Provider Demographics
NPI:1619940566
Name:BABCOCK, MATTHEW JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BABCOCK
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 1:7736 MARY ELLEN PL
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3467
Mailing Address - Country:US
Mailing Address - Phone:262-893-3455
Mailing Address - Fax:
Practice Address - Street 1:2505 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1404
Practice Address - Country:US
Practice Address - Phone:414-258-2117
Practice Address - Fax:414-258-4117
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice