Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5401 | WI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 5603-015 | WI |
NPI | 1003823436 |
---|---|
Provider Name | Dr. Christopher Patrick Mcaboy |
First Address | Glendale, WI 53212 |
Second Address | Glendale, WI 53212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 25/09/2020 |