Provider Demographics
NPI:1710327960
Name:MCCABE, MAEGEN CALHOUN (DMD)
Entity Type:Individual
Prefix:
First Name:MAEGEN
Middle Name:CALHOUN
Last Name:MCCABE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MAEGEN
Other - Middle Name:C
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15236 DEDEAUX RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3161
Mailing Address - Country:US
Mailing Address - Phone:601-385-5805
Mailing Address - Fax:
Practice Address - Street 1:15236 DEDEAUX RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3161
Practice Address - Country:US
Practice Address - Phone:228-832-3111
Practice Address - Fax:228-832-3117
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP11701223P0221X
ALD62521223P0221X
MS3782-151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03458379Medicaid