Provider Demographics
NPI:1700983749
Name:MCINTYRE, DOUGLAS JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAMES
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3109
Mailing Address - Country:US
Mailing Address - Phone:740-374-7060
Mailing Address - Fax:740-374-0023
Practice Address - Street 1:123 3RD ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3109
Practice Address - Country:US
Practice Address - Phone:740-374-7060
Practice Address - Fax:740-374-0023
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 . 013617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist