Healthcare Provider Details

I. General information

NPI: 1225182082
Provider Name (Legal Business Name): MARK JOHN ESCOTO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 PROFESSIONAL CT
LAS VEGAS NV
89128-0830
US

IV. Provider business mailing address

2471 PROFESSIONAL CT
LAS VEGAS NV
89128-0830
US

V. Phone/Fax

Practice location:
  • Phone: 702-256-5353
  • Fax: 702-243-7581
Mailing address:
  • Phone: 702-256-5353
  • Fax: 702-243-7581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2679
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: