MEDICARE: DR. PETER AUGUSTINE MCINTYRE D.D.S.

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	106239	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619976404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER AUGUSTINE MCINTYRE D.D.S.

Provider Business Mailing Address
First Line	:	595 CHAPEL HILLS DRIVE
Second Line	:	SUITE 105
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920
Country	:	US
Telephone Number	:	719-475-2511
Fax Number	:	719-475-8425

Provider Business Practice Location Address
First Line	:	595 CHAPEL HILLS DR
Second Line	:	SUITE 105
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1022
Country	:	US
Telephone Number	:	719-475-2511
Fax Number	:	719-475-8425

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/09/2012

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