Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901019380 | MI |
Y | 1223P0300X | Periodontist | DEN1000851 | DC |
NPI | 1114135548 |
---|---|
Provider Name | Crystal L Mcintosh |
First Address | Washington, DC 20011-3906 |
Second Address | Washington, DC 20059-1022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 04/03/2010 |