Provider Demographics
NPI:1396737557
Name:PARCO, TODD M (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:PARCO
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:4435 ORGAN MESA LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8404
Mailing Address - Country:US
Mailing Address - Phone:575-526-5522
Mailing Address - Fax:575-523-5312
Practice Address - Street 1:1901 CALLE DE NINOS
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3293
Practice Address - Country:US
Practice Address - Phone:575-526-5522
Practice Address - Fax:575-523-5312
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO83061223G0001X
NMDD24451223P0221X
TX257621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30259037Medicaid
NM31677592Medicaid
01316253OtherUNITED CONCORDIA