Healthcare Provider Details

I. General information

NPI: 1073120135
Provider Name (Legal Business Name): REUEL MCINTYRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E OHIO AVE
ESCONDIDO CA
92025-3438
US

IV. Provider business mailing address

8061 ALAMEDA AVE
EL PASO TX
79915-4705
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax:
Mailing address:
  • Phone: 915-859-7545
  • Fax: 915-859-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number104782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35884
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: