Provider Demographics
NPI:1891944781
Name:PADILLA, MARCO TULIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:TULIO
Last Name:PADILLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1811 SOUTH RAINBOW BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0855
Mailing Address - Country:US
Mailing Address - Phone:702-263-4300
Mailing Address - Fax:702-256-7912
Practice Address - Street 1:1811 SOUTH RAINBOW BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0855
Practice Address - Country:US
Practice Address - Phone:702-263-4300
Practice Address - Fax:702-256-7912
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVS5-121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics