Provider Demographics
NPI:1770597411
Name:MACINTYRE, RODERICK M III (DMD; MS)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:M
Last Name:MACINTYRE
Suffix:III
Gender:M
Credentials:DMD; MS
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Mailing Address - Street 1:912 S RIDGEWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5349
Mailing Address - Country:US
Mailing Address - Phone:386-252-0858
Mailing Address - Fax:386-253-7004
Practice Address - Street 1:912 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5349
Practice Address - Country:US
Practice Address - Phone:386-252-0858
Practice Address - Fax:386-253-7004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDN127431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics