Provider Demographics
NPI:1285838391
Name:PALERMO, MARCUS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:L
Last Name:PALERMO
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 1:2100 CALLE DE LA VUELTA
Mailing Address - Street 2:SUITE C-102
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-988-3636
Mailing Address - Fax:505-501-7557
Practice Address - Street 1:2100 CALLE DE LA VUELTA
Practice Address - Street 2:SUITE C-102
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4742
Practice Address - Country:US
Practice Address - Phone:505-988-3636
Practice Address - Fax:505-501-7557
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD73271223E0200X
NMDD31951223E0200X
PADS0370261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice