Provider Demographics
NPI:1376841015
Name:CHRISTOPHER P. MCABOY DDS, LLC
Entity Type:Organization
Organization Name:CHRISTOPHER P. MCABOY DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCABOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-906-8940
Mailing Address - Street 1:377 W RIVER WOODS PKWY # 120
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1088
Mailing Address - Country:US
Mailing Address - Phone:414-906-8940
Mailing Address - Fax:
Practice Address - Street 1:377 W RIVER WOODS PKWY # 120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1088
Practice Address - Country:US
Practice Address - Phone:414-906-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5603-0151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003823436Medicaid