Provider Demographics
NPI:1063197184
Name:ENCHANTED DENTAL CARE PLLC
Entity type:Organization
Organization Name:ENCHANTED DENTAL CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CRODDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-606-4522
Mailing Address - Street 1:3700 PECOS MCLEOD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4259
Mailing Address - Country:US
Mailing Address - Phone:702-850-0029
Mailing Address - Fax:
Practice Address - Street 1:3700 PECOS MCLEOD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4259
Practice Address - Country:US
Practice Address - Phone:702-732-2333
Practice Address - Fax:702-732-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty