Healthcare Provider Details

I. General information

NPI: 1477518942
Provider Name (Legal Business Name): MARJORIE MAE CABELL D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E DIAMOND AVE
EVANSVILLE IN
47711-3714
US

IV. Provider business mailing address

400 E DIAMOND AVE
EVANSVILLE IN
47711-3714
US

V. Phone/Fax

Practice location:
  • Phone: 812-461-2365
  • Fax: 812-461-2366
Mailing address:
  • Phone: 812-461-2365
  • Fax: 812-461-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS029852L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN013492
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013492
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12013316A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: