Provider Demographics
NPI:1225182082
Name:ESCOTO, MARK JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:ESCOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0830
Mailing Address - Country:US
Mailing Address - Phone:702-256-5353
Mailing Address - Fax:702-243-7581
Practice Address - Street 1:2471 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0830
Practice Address - Country:US
Practice Address - Phone:702-256-5353
Practice Address - Fax:702-243-7581
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV26791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV880382251Medicare UPIN