Provider Demographics
NPI:1922411297
Name:MCCABE ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:MCCABE ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, MBA
Authorized Official - Phone:228-497-9844
Mailing Address - Street 1:4341 GAUTIER VANCLEAVE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-4825
Mailing Address - Country:US
Mailing Address - Phone:228-497-9844
Mailing Address - Fax:228-497-9499
Practice Address - Street 1:4341 GAUTIER VANCLEAVE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-4825
Practice Address - Country:US
Practice Address - Phone:228-497-9844
Practice Address - Fax:228-497-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3541-101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty