Provider Demographics
NPI:1164866125
Name:TENTINDO, GREGORY STEPHEN (DMD, MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:STEPHEN
Last Name:TENTINDO
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 16A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8239
Mailing Address - Country:US
Mailing Address - Phone:314-251-6725
Mailing Address - Fax:314-251-6726
Practice Address - Street 1:621 S NEW BALLAS RD STE 16A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8239
Practice Address - Country:US
Practice Address - Phone:314-251-6725
Practice Address - Fax:314-251-6726
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613731223S0112X
390200000X
MO2017017757204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program