MEDICARE: KYLE STEPHEN MCINTYRE 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
1	1223G0001X	General Practice Dentistry	D-4498	ID
2	1223G0001X	General Practice Dentistry	DEN-DEN-LIC-5992	MT

General Provider Information

NPI Number	:	1477980605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE STEPHEN MCINTYRE DDS

Provider Business Mailing Address
First Line	:	820 SAMPSON ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-3208
Country	:	US
Telephone Number	:	406-494-7080
Fax Number	:	406-494-4634

Provider Business Practice Location Address
First Line	:	820 SAMPSON ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-3208
Country	:	US
Telephone Number	:	406-494-7080
Fax Number	:	406-494-4634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	08/14/2014

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Directions to “ KYLE STEPHEN MCINTYRE DDS” Practice Location

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