Provider Demographics
NPI:1548365190
Name:MCINTOSH, DEBRA C (DMD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:C
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9671
Mailing Address - Country:US
Mailing Address - Phone:513-573-9949
Mailing Address - Fax:513-573-9367
Practice Address - Street 1:3615 SOCIALVILLE FOSTER RD
Practice Address - Street 2:SUITE E
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9671
Practice Address - Country:US
Practice Address - Phone:513-573-9949
Practice Address - Fax:513-573-9367
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH19715OtherLICENSE NUMBER