Organization
ADVANCED ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN MCCABE DMD, MD (ORAL & MAXILLOFACIAL SURGEON)
(507) 327-9574
Entity
Organization
Contact information
Practice address
19925 IDEALIC AVE, LAKEVILLE, MN 55044-2003
(507) 327-9574
Mailing address
19318 IMPALA AVE, LAKEVILLE, MN 55044-1600
(507) 327-9574
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023307113
—
FL
Enumeration date
09/13/2018
Last updated
09/13/2018
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