MEDICARE: DR. RODERICK M MACINTYRE III D.M.D.; M.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	1223E0200X	Endodontics	DN12743	FL

General Provider Information

NPI Number	:	1770597411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODERICK M MACINTYRE III D.M.D.; M.S.

Provider Business Mailing Address
First Line	:	912 S RIDGEWOOD AVE
Second Line	:	SUITE C
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5349
Country	:	US
Telephone Number	:	386-252-0858
Fax Number	:	386-253-7004

Provider Business Practice Location Address
First Line	:	912 S RIDGEWOOD AVE
Second Line	:	SUITE C
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5349
Country	:	US
Telephone Number	:	386-252-0858
Fax Number	:	386-253-7004

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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