MEDICARE: DR. ROBERT LOUIS MCINTOSH 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	30.016553	OH

General Provider Information

NPI Number	:	1699848465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LOUIS MCINTOSH DDS

Provider Business Mailing Address
First Line	:	PO BOX 33
Second Line	:
City	:	NORTH JACKSON
State	:	OH
Zip	:	44451-0033
Country	:	US
Telephone Number	:	330-538-3304
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 LIBERTY ST.
Second Line	:
City	:	NORTH JACKSON
State	:	OH
Zip	:	44451-8706
Country	:	US
Telephone Number	:	330-538-3304
Fax Number	:	330-538-3305

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	08/26/2021

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