Provider Demographics
NPI:1073555140
Name:GARRIDO, DANTE O (MD)
Entity Type:Individual
Prefix:MR
First Name:DANTE
Middle Name:O
Last Name:GARRIDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12963 WALNUTWAY TER
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-6047
Mailing Address - Country:US
Mailing Address - Phone:314-878-4312
Mailing Address - Fax:
Practice Address - Street 1:12963 WALNUTWAY TER
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-6047
Practice Address - Country:US
Practice Address - Phone:314-878-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR89982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200742831Medicaid
MO5424OtherBLUE CROSS/BLUE SHIELD
MO0500083OtherUNITEDHEALTHCARE
MO00005735Medicare PIN
MO200742831Medicaid