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NPI Code Detail

MEDICARE: DR. JACK DOUGLAS MCINTYRE JR. DDS

MEDICARE: DR. JACK DOUGLAS MCINTYRE JR. DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2901013617MI

General Provider Information

NPI Number : 1477765717
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK DOUGLAS MCINTYRE JR. DDS
Provider Business Mailing Address
First Line : 3168 PORT SHELDON ST
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-9317
Country : US
Telephone Number : 616-669-3900
Fax Number : 616-669-3913
Provider Business Practice Location Address
First Line : 3168 PORT SHELDON ST
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-9317
Country : US
Telephone Number : 616-669-3900
Fax Number : 616-669-3913
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2007
Last Update Date : 08/04/2009

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