MEDICARE: ENCHANTED DENTAL CARE PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1063197184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCHANTED DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	3700 PECOS MCLEOD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4259
Country	:	US
Telephone Number	:	702-732-2333
Fax Number	:	702-732-0881

Provider Business Practice Location Address
First Line	:	3700 PECOS MCLEOD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4259
Country	:	US
Telephone Number	:	702-732-2333
Fax Number	:	702-732-0881

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DAVID CRODDY
Credential	:	DDS
Telephone Number	:	702-732-2333

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	09/03/2025

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