Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 61373 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2017017757 | MO |
NPI | 1164866125 |
---|---|
Provider Name | Gregory Stephen Tentindo |
First Address | Saint Louis, MO 63141-8239 |
Second Address | Saint Louis, MO 63141-8239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 04/09/2019 |