Provider Demographics
NPI:1801926548
Name:MCCABE, RUSSELL (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:MCCABE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 N NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3169
Mailing Address - Country:US
Mailing Address - Phone:812-376-9425
Mailing Address - Fax:812-376-9428
Practice Address - Street 1:3142 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3169
Practice Address - Country:US
Practice Address - Phone:812-376-9425
Practice Address - Fax:812-376-9428
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120099781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics