Provider Demographics
NPI:1447412754
Name:CABELL DENTAL GROUP LLC
Entity Type:Organization
Organization Name:CABELL DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:CABELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-707-7905
Mailing Address - Street 1:990 BEAR CREEK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228
Mailing Address - Country:US
Mailing Address - Phone:770-707-7905
Mailing Address - Fax:770-707-7923
Practice Address - Street 1:990 BEAR CREEK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-1864
Practice Address - Country:US
Practice Address - Phone:770-707-7905
Practice Address - Fax:770-707-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty