Provider Demographics
NPI:1790998151
Name:DIANE MCINTYRE DDS PS
Entity Type:Organization
Organization Name:DIANE MCINTYRE DDS PS
Other - Org Name:WALLINGFORD DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-633-4007
Mailing Address - Street 1:3941 WALLINGFORD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8247
Mailing Address - Country:US
Mailing Address - Phone:206-633-4007
Mailing Address - Fax:206-633-2504
Practice Address - Street 1:3941 WALLINGFORD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8247
Practice Address - Country:US
Practice Address - Phone:206-633-4007
Practice Address - Fax:206-633-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA52881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty