Provider Demographics
NPI:1811069164
Name:MCCABE DENTAL CLINIC
Entity type:Organization
Organization Name:MCCABE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-896-7404
Mailing Address - Street 1:PO BOX 7239
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506
Mailing Address - Country:US
Mailing Address - Phone:228-896-7404
Mailing Address - Fax:228-896-6048
Practice Address - Street 1:512 COWAN RD
Practice Address - Street 2:
Practice Address - City:GULPORT
Practice Address - State:MS
Practice Address - Zip Code:39507
Practice Address - Country:US
Practice Address - Phone:228-896-7404
Practice Address - Fax:228-896-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty