Provider Demographics
NPI:1922147289
Name:LIVEOAK, TALMADGE WADE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TALMADGE
Middle Name:WADE
Last Name:LIVEOAK
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 1:2227 DRAKE AVE SW
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805
Mailing Address - Country:US
Mailing Address - Phone:256-882-2227
Mailing Address - Fax:256-882-2252
Practice Address - Street 1:2227 DRAKE AVE SW
Practice Address - Street 2:SUITE 10A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805
Practice Address - Country:US
Practice Address - Phone:256-882-2227
Practice Address - Fax:256-882-2252
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51094172OtherBLUE CROSS PROVIDER NUMBE
AL872873OtherUNITED CONCORDIA PROVIDER