Provider Demographics
NPI:1154667715
Name:CABLE ORTHODONTICS, PC
Entity Type:Organization
Organization Name:CABLE ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-992-1001
Mailing Address - Street 1:2903 MOUNT ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-1633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2903 MOUNT ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-1633
Practice Address - Country:US
Practice Address - Phone:412-992-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0358641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty