Healthcare Provider Details

I. General information

NPI: 1003823436
Provider Name (Legal Business Name): CHRISTOPHER PATRICK MCABOY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 W RIVER WOODS PARKWAY SUITE #120
GLENDALE WI
53212
US

IV. Provider business mailing address

377 W RIVER WOODS PARKWAY SUITE #120
GLENDALE WI
53212
US

V. Phone/Fax

Practice location:
  • Phone: 414-906-8940
  • Fax: 414-906-8950
Mailing address:
  • Phone: 414-906-8940
  • Fax: 414-906-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5401
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5603-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: