MEDICARE: DR. MARCO TULIO PADILLA D.M.D.

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	1223P0700X	Prosthodontics	S5-12	NV

General Provider Information

NPI Number	:	1891944781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCO TULIO PADILLA D.M.D.

Provider Business Mailing Address
First Line	:	1811 SOUTH RAINBOW BLVD
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0855
Country	:	US
Telephone Number	:	702-263-4300
Fax Number	:	702-256-7912

Provider Business Practice Location Address
First Line	:	1811 SOUTH RAINBOW BLVD
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0855
Country	:	US
Telephone Number	:	702-263-4300
Fax Number	:	702-256-7912

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

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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