Provider Demographics
NPI:1396905709
Name:MCCABE, MOLLIE MARIE (DDS)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:MARIE
Last Name:MCCABE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:MARIE
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2027 N 54TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4235
Mailing Address - Country:US
Mailing Address - Phone:402-290-0319
Mailing Address - Fax:
Practice Address - Street 1:12100 WEST CENTER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144
Practice Address - Country:US
Practice Address - Phone:402-330-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist