Jack Douglas McIntyre Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901013617 Issued in MI

Practice address

3168 Port Sheldon St
Hudsonville, MI 49426-9317

Phone

(616) 669-3900

Fax

(616) 669-3913

NPI assigned

May 6, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249344000000",
    "number": "1477765717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3168 PORT SHELDON ST",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494269317",
            "telephone_number": "616-669-3900",
            "fax_number": "616-669-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3168 PORT SHELDON ST",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494269317",
            "telephone_number": "616-669-3900",
            "fax_number": "616-669-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTYRE",
        "first_name": "JACK",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-06",
        "last_updated": "2009-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901013617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Mastbergen
• Bonny Kaye Matthysse, RDH
• Jessica Anne McConnell, CCC-SLP
• Joshua McCullen, DPT
• Larayne McGahan, OTR/L
• Meijer, Inc.
• Kurt Meppelink, DO
• Jordan Ross Meyer, DO
• Kristin Meyerdirk, COTA/L
• Michigan Medical Patient Care

• General Practice Dentistry in Hudsonville, MI
• Providers in Hudsonville, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.