Provider Demographics
NPI:1740657915
Name:MARKETTO, DOMINIC LAWRENCE IV (DDS)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:LAWRENCE
Last Name:MARKETTO
Suffix:IV
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 1:2980 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1152
Mailing Address - Country:US
Mailing Address - Phone:575-524-3722
Mailing Address - Fax:575-524-9826
Practice Address - Street 1:2980 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1152
Practice Address - Country:US
Practice Address - Phone:575-524-3722
Practice Address - Fax:575-524-9826
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist