Provider Demographics
NPI:1740354364
Name:MCINTYRE, MARSHA G (DMD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:G
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 N HUBBARDS LN STE 110
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-8209
Mailing Address - Country:US
Mailing Address - Phone:502-897-6282
Mailing Address - Fax:502-897-6286
Practice Address - Street 1:291 N HUBBARDS LN STE 110
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-8209
Practice Address - Country:US
Practice Address - Phone:502-897-6282
Practice Address - Fax:502-897-6286
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY78651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice