Healthcare Provider Details

I. General information

NPI: 1992708689
Provider Name (Legal Business Name): JOHN S MCINTYRE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HANSON PL STE 705 SUITE 705
BROOKLYN NY
11243-2907
US

IV. Provider business mailing address

1 HANSON PL STE 705 SUITE 705
BROOKLYN NY
11243-2907
US

V. Phone/Fax

Practice location:
  • Phone: 718-638-2200
  • Fax: 718-638-2286
Mailing address:
  • Phone: 718-638-2200
  • Fax: 718-638-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number035159
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: