Basic Information
| Provider Information | |||||||||
| NPI: | 1922489103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAREDES | ||||||||
| FirstName: | DANTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 MONTGOMERY ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761072553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177352228 | ||||||||
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| Practice Location | |||||||||
| Address1: | 855 MONTGOMERY ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761072553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177352228 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2015 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | R9264 | TX | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 207Q00000X | R9264 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.