Provider Demographics
NPI:1306110747
Name:ENCHANTED SMILES
Entity type:Organization
Organization Name:ENCHANTED SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DURGAPERSAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-540-7724
Mailing Address - Street 1:7031 FM 1960 RD W
Mailing Address - Street 2:STE F
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3429
Mailing Address - Country:US
Mailing Address - Phone:281-540-7724
Mailing Address - Fax:281-540-7728
Practice Address - Street 1:7031 FM 1960 RD W
Practice Address - Street 2:STE F
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3429
Practice Address - Country:US
Practice Address - Phone:281-540-7724
Practice Address - Fax:281-540-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty