Provider Demographics
NPI:1962666719
Name:TIBURCIO, DON MARQUE (DDS)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:MARQUE
Last Name:TIBURCIO
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 1:6084 SECRET ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6250
Mailing Address - Country:US
Mailing Address - Phone:818-726-9510
Mailing Address - Fax:
Practice Address - Street 1:6084 SECRET ISLAND DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6250
Practice Address - Country:US
Practice Address - Phone:818-726-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist