Provider Demographics
NPI:1174185805
Name:BARO, ANNIE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:MARIE
Last Name:BARO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-890-8183
Mailing Address - Fax:
Practice Address - Street 1:102 COMPASS POINT DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4404
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190195791223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400071184Medicaid