Provider Demographics
NPI:1891886578
Name:PORCO, MARK DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:PORCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:898 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1774
Mailing Address - Country:US
Mailing Address - Phone:916-645-6286
Mailing Address - Fax:916-645-0114
Practice Address - Street 1:898 5TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1774
Practice Address - Country:US
Practice Address - Phone:916-645-6286
Practice Address - Fax:916-645-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice