Healthcare Provider Details

I. General information

NPI: 1386176675
Provider Name (Legal Business Name): CABEL A MCDONALD DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 11TH AVE STE B
LONGVIEW WA
98632-2461
US

IV. Provider business mailing address

3238 STONE EDGE RD
EL PASO TX
79904-2428
US

V. Phone/Fax

Practice location:
  • Phone: 253-459-5483
  • Fax:
Mailing address:
  • Phone: 253-459-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberDE00010956
License Number StateWA

VIII. Authorized Official

Name: DR. CABEL ARON MCDONALD
Title or Position: OWNER
Credential: DDS
Phone: 253-459-5483