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General NPI Number Information
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NPI Number | 1194039743
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Entity Type | Organization
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Legal Business Name | ENCHANTMENT ORTHODONTICS, LLC
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 1901 CALLE DE NINOS UNIT 3
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City | LAS CRUCES
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State | NM
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Zip | 88005-3293
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Country | US
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Telephone | 575-201-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 CALLE DE NINOS UNIT 3
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City | LAS CRUCES
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State | NM
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Zip | 88005-3293
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Country | US
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Telephone | 575-201-7100
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Fax |
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Authorized Official
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Title or Position | OWNER AND PEDIATRIC DENTIST
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Name | DR. TODD MICHAEL PARCO
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Credential | DDS MSD
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Telephone | 575-526-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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