Provider Demographics
NPI:1821081118
Name:MCINTOSH, ROLEY DALE (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:ROLEY
Middle Name:DALE
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:918-618-4204
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:918-618-4204
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist