| Agave Dental Fun Zone Pllc | |
|
10501 Gateway Blvd W Ste 107 El Paso TX 79925-7956 | |
| (915) 204-6941 | |
| Not Available |
| Full Name | Agave Dental Fun Zone Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 10501 Gateway Blvd W Ste 107, El Paso, Texas |
| Authorized Official Name and Position | Anthony Kasallis (DENTIST) |
| Authorized Official Contact | 9158330303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Agave Dental Fun Zone Pllc 6309 Natalicio Ln El Paso TX 79912-1859 Ph: (915) 204-6941 | Agave Dental Fun Zone Pllc 10501 Gateway Blvd W Ste 107 El Paso TX 79925-7956 Ph: (915) 204-6941 |
| NPI Number | 1861106114 |
|---|---|
| Provider Enumeration Date | 01/11/2023 |
| Last Update Date | 01/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861106114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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