Provider Demographics
NPI:1760656771
Name:S. P, MCINTOSH, DDS, PLLC
Entity Type:Organization
Organization Name:S. P, MCINTOSH, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-689-2583
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-0899
Mailing Address - Country:US
Mailing Address - Phone:918-689-2583
Mailing Address - Fax:918-689-1838
Practice Address - Street 1:900 BIRKES RD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4023
Practice Address - Country:US
Practice Address - Phone:918-689-2583
Practice Address - Fax:918-689-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK03772261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental