Provider Demographics
NPI:1023090727
Name:MCINTYRE, JOSEPH M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 OAK WOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-9544
Mailing Address - Country:US
Mailing Address - Phone:540-828-2312
Mailing Address - Fax:540-828-2857
Practice Address - Street 1:115 OAK WOOD DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-9544
Practice Address - Country:US
Practice Address - Phone:540-828-2312
Practice Address - Fax:540-828-2857
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4010060191223G0001X
VA04010060191223S0112X, 207QG0300X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
744585OtherPROVIDER# UNITED CONCORDI
004-562OtherPROVIDER ID ANTHEM BC/BS