MEDICARE: DR. MARCUS L PALERMO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	D7327	AZ
2	1223E0200X	Endodontics	DD3195	NM
3	1223G0001X	General Practice Dentistry	DS037026	PA

General Provider Information

NPI Number	:	1285838391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS L PALERMO DDS

Provider Business Mailing Address
First Line	:	2100 CALLE DE LA VUELTA
Second Line	:	SUITE C-102
City	:	SANTA FE
State	:	NM
Zip	:	87505
Country	:	US
Telephone Number	:	505-988-3636
Fax Number	:	505-501-7557

Provider Business Practice Location Address
First Line	:	2100 CALLE DE LA VUELTA
Second Line	:	SUITE C-102
City	:	SANTA FE
State	:	NM
Zip	:	87505-4742
Country	:	US
Telephone Number	:	505-988-3636
Fax Number	:	505-501-7557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	03/28/2012

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