Healthcare Provider Details

I. General information

NPI: 1871611996
Provider Name (Legal Business Name): FREDERICK MICHAEL MCINTYRE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210A SQUIRE HALL UNIVERSITY DENTAL ASSOCIATES UB SCHOOL OF DENTAL MEDICINE
BUFFALO NY
14214
US

IV. Provider business mailing address

1 MAYFIELD DR
WEST SENECA NY
14224-1465
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2862
  • Fax: 716-829-2440
Mailing address:
  • Phone: 716-481-2560
  • Fax: 716-829-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number029804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: