Provider Demographics
NPI:1578303954
Name:FRANCO-DI TORE, MARIO (DMD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:FRANCO-DI TORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7553 PARKDALE AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2813
Mailing Address - Country:US
Mailing Address - Phone:419-460-3258
Mailing Address - Fax:
Practice Address - Street 1:3708 JENNINGS STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-3500
Practice Address - Country:US
Practice Address - Phone:314-382-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240181901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty