# ADVANCED ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295218303
- **Authorized official:** DR. JONATHAN MCCABE DMD, MD (ORAL & MAXILLOFACIAL SURGEON)
- **Authorized official phone:** (507) 327-9574

## Contact information

- **Practice address:** 19925 IDEALIC AVE, LAKEVILLE, MN 55044-2003
- **Practice address phone:** (507) 327-9574
- **Mailing address:** 19318 IMPALA AVE, LAKEVILLE, MN 55044-1600
- **Mailing address phone:** (507) 327-9574

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/13/2018
- **Last updated:** 09/13/2018