Provider Demographics
NPI:1194039743
Name:ENCHANTMENT ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:ENCHANTMENT ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:575-526-5522
Mailing Address - Street 1:1901 CALLE DE NINOS UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3293
Mailing Address - Country:US
Mailing Address - Phone:575-201-7100
Mailing Address - Fax:
Practice Address - Street 1:1901 CALLE DE NINOS UNIT 3
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3293
Practice Address - Country:US
Practice Address - Phone:575-201-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty