# AGAVE DENTAL BRIGHT STAR PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bright Star Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275230518
- **Authorized official:** DR. JAKE WILLIAMS DDS (MEMBER)
- **Authorized official phone:** (385) 335-0928

## Contact information

- **Practice address:** 2010 E LOHMAN AVE STE A, LAS CRUCES, NM 88001-3109
- **Practice address phone:** (575) 526-4334
- **Practice address fax:** (575) 526-7863
- **Mailing address:** 2010 E LOHMAN AVE STE A, LAS CRUCES, NM 88001-3109
- **Mailing address phone:** (575) 526-4334
- **Mailing address fax:** (575) 526-7863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/07/2023
- **Last updated:** 02/07/2023