Provider Demographics
NPI:1992250047
Name:DAVID N. MCINTIRE,DDS
Entity type:Organization
Organization Name:DAVID N. MCINTIRE,DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MCINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-622-4800
Mailing Address - Street 1:4280 GOLDEN CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6290
Mailing Address - Country:US
Mailing Address - Phone:530-622-4800
Mailing Address - Fax:530-622-4850
Practice Address - Street 1:4280 GOLDEN CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6290
Practice Address - Country:US
Practice Address - Phone:530-622-4800
Practice Address - Fax:530-622-4850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID N MCINTIRE,DDS.,INC ORAL AND MAXILLOFACIAL SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032876305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service