Healthcare Provider Details

I. General information

NPI: 1205890167
Provider Name (Legal Business Name): WILLIAM OLIVER MCINTIRE DMD,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11777 BERNARDO PLAZA CT
SAN DIEGO CA
92128-2405
US

IV. Provider business mailing address

11777 BERNARDO PLAZA CT
SAN DIEGO CA
92128-2450
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-7766
  • Fax: 858-487-5539
Mailing address:
  • Phone: 858-487-7766
  • Fax: 858-487-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number32132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: