Provider Demographics
NPI:1710085808
Name:MCINTYRE, ROBERT ALLISON (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLISON
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4147
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91617
Mailing Address - Country:US
Mailing Address - Phone:818-985-9315
Mailing Address - Fax:
Practice Address - Street 1:4910 VAN NUYS BLVD.
Practice Address - Street 2:#204
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-985-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0321331223G0001X
CA321331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice