# AGAVE DENTAL LLC

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

## Provider details

- **NPI number:** 1851780852
- **Authorized official:** MONICA DEWITT (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (602) 914-4274

## Contact information

- **Practice address:** 4235 N 32ND ST, SUITE C, PHOENIX, AZ 85018-4766
- **Practice address phone:** (602) 957-2411
- **Mailing address:** PO BOX 61025, PHOENIX, AZ 85082-1025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | F000375 | AZ | Yes |

## Other

- **Enumeration date:** 01/13/2015
- **Last updated:** 05/22/2023