Healthcare Provider Details

I. General information

NPI: 1396737557
Provider Name (Legal Business Name): TODD M. PARCO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CALLE DE NINOS
LAS CRUCES NM
88005-3293
US

IV. Provider business mailing address

4435 ORGAN MESA LOOP
LAS CRUCES NM
88011-8404
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-5522
  • Fax: 575-523-5312
Mailing address:
  • Phone: 575-526-5522
  • Fax: 575-523-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8306
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDD2445
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number25762
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: