Provider Demographics
NPI:1992708689
Name:MCINTYRE, JOHN S (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HANSON PL STE 705
Mailing Address - Street 2:SUITE 705
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11243-2907
Mailing Address - Country:US
Mailing Address - Phone:718-638-2200
Mailing Address - Fax:718-638-2286
Practice Address - Street 1:1 HANSON PL STE 705
Practice Address - Street 2:SUITE 705
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11243-2907
Practice Address - Country:US
Practice Address - Phone:718-638-2200
Practice Address - Fax:718-638-2286
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0351591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035159OtherLISCENSE
NY00762969Medicaid
NYT49259Medicare UPIN
NY035159OtherLISCENSE