# AGAVE DENTAL CARE NORTH EAST, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295499739
- **Authorized official:** MR. JAKE RUSSELL WILLIAMS D.D.S. (OWNER/DENTIST)
- **Authorized official phone:** (915) 755-7697

## Contact information

- **Practice address:** 8815 DYER ST SUITE 210, EL PASO, TX 79904
- **Practice address phone:** (915) 755-7697
- **Practice address fax:** (915) 751-1056
- **Mailing address:** 8815 DYER ST SUITE 210, EL PASO, TX 79904
- **Mailing address phone:** (915) 755-7697
- **Mailing address fax:** (915) 751-1056

## Taxonomy

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

## Other

- **Enumeration date:** 10/29/2021
- **Last updated:** 10/29/2021