Provider Demographics
NPI:1831241173
Name:BABBAGE MELISIZWE, SHERRY C (DMD)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:C
Last Name:BABBAGE MELISIZWE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1081
Mailing Address - Country:US
Mailing Address - Phone:502-776-1754
Mailing Address - Fax:502-778-2301
Practice Address - Street 1:2500 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1081
Practice Address - Country:US
Practice Address - Phone:502-776-1754
Practice Address - Fax:502-778-2301
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60053766Medicaid