# AGAVE DENTAL FUN ZONE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Fun Zone
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861106114
- **Authorized official:** DR. ANTHONY KASALLIS DDS (DENTIST)
- **Authorized official phone:** (915) 833-0303

## Contact information

- **Practice address:** 10501 GATEWAY BLVD W STE 107, EL PASO, TX 79925-7956
- **Practice address phone:** (915) 204-6941
- **Mailing address:** 6309 NATALICIO LN, EL PASO, TX 79912-1859
- **Mailing address phone:** (915) 204-6941

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/11/2023
- **Last updated:** 01/11/2023