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General NPI Number Information
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NPI Number | 1558625913
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Entity Type | Individual
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Provider Name | MOLLY CONSTANCE MCINTOSH D.D.S
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Gender | Female
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Dates
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Enumeration Date | 06/30/2012
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Last Update Date | 06/30/2012
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Provider Practice Location Address
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Address Line | 8410 DATAPOINT DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3220
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Country | US
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Telephone | 210-617-5208
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Fax |
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Provider Business Mailing Address
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Address Line | 8602 CINNAMON CREEK DR APT 715
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City | SAN ANTONIO
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State | TX
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Zip | 78240-5812
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Country | US
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Telephone | 206-713-9779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60297651
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License Number State | WA
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