=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336590637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN G. MCINTYRE DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2016
-----------------------------------------------------
Last Update Date | 06/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 W MARSHALL ST
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19401-4546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-222-6152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 N BRYN MAWR AVE #285
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-222-6152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN G MCINTYRE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 215-869-5721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS023368L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------