Provider Demographics
NPI:1316967821
Name:SCARBERRY, MATT (DDS)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:SCARBERRY
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 1:2035 KANAWHA TER
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-3187
Mailing Address - Country:US
Mailing Address - Phone:304-727-2222
Mailing Address - Fax:304-727-0277
Practice Address - Street 1:2035 KANAWHA TER
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-3187
Practice Address - Country:US
Practice Address - Phone:304-727-2222
Practice Address - Fax:304-727-0277
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005869Medicaid
KY60004512Medicaid