Provider Demographics
NPI:1073120135
Name:MCINTYRE, REUEL
Entity Type:Individual
Prefix:
First Name:REUEL
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8061 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-4705
Mailing Address - Country:US
Mailing Address - Phone:915-859-7545
Mailing Address - Fax:915-859-9862
Practice Address - Street 1:8061 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-4705
Practice Address - Country:US
Practice Address - Phone:915-859-7545
Practice Address - Fax:915-859-9862
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX358841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice