Provider Demographics
NPI:1982802351
Name:MCINTYRE, JANE MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MARIE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37615 NE 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-4442
Mailing Address - Country:US
Mailing Address - Phone:360-601-0396
Mailing Address - Fax:
Practice Address - Street 1:37615 NE 142ND AVE
Practice Address - Street 2:
Practice Address - City:LA CENTER
Practice Address - State:WA
Practice Address - Zip Code:98629-4442
Practice Address - Country:US
Practice Address - Phone:360-601-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHL00007265124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5902299Medicaid