Provider Demographics
NPI:1740742881
Name:MACINTOSH, BETHANY JOY (DMD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:MACINTOSH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6357 SHOWY CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3727
Mailing Address - Country:US
Mailing Address - Phone:850-266-5988
Mailing Address - Fax:
Practice Address - Street 1:4625 VIRGINIA BEACH BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7789
Practice Address - Country:US
Practice Address - Phone:757-675-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014164471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice