MEDICARE: CABLE ORTHODONTICS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS035864	PA

General Provider Information

NPI Number	:	1154667715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABLE ORTHODONTICS, PC

Provider Business Mailing Address
First Line	:	2903 MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-1633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2903 MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-1633
Country	:	US
Telephone Number	:	412-992-1001
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. CLINTON L CABLE
Credential	:	DMD
Telephone Number	:	412-992-1001

Provider Enumeration Date	:	12/28/2012
Last Update Date	:	12/28/2012

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