Provider Demographics
NPI:1336590637
Name:JOHN G. MCINTYRE DDS PC
Entity Type:Organization
Organization Name:JOHN G. MCINTYRE DDS PC
Other - Org Name:ABOUT STRAIGHT TEETH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-869-5721
Mailing Address - Street 1:24 N BRYN MAWR AVE
Mailing Address - Street 2:#285
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3304
Mailing Address - Country:US
Mailing Address - Phone:610-222-6152
Mailing Address - Fax:
Practice Address - Street 1:610 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4546
Practice Address - Country:US
Practice Address - Phone:610-222-6152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023368L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty