Healthcare Provider Details

I. General information

NPI: 1982802351
Provider Name (Legal Business Name): JANE MARIE MCINTYRE R.D.H
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37615 NE 142ND AVE
LA CENTER WA
98629-4442
US

IV. Provider business mailing address

37615 NE 142ND AVE
LA CENTER WA
98629-4442
US

V. Phone/Fax

Practice location:
  • Phone: 360-601-0396
  • Fax:
Mailing address:
  • Phone: 360-601-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHL00007265
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: