Organization
AGAVE DENTAL CARE NORTH EAST, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAKE RUSSELL WILLIAMS D.D.S. (OWNER/DENTIST)
(915) 755-7697
Entity
Organization
Contact information
Practice address
8815 DYER ST SUITE 210, EL PASO, TX 79904
(915) 755-7697
(915) 751-1056
Mailing address
8815 DYER ST SUITE 210, EL PASO, TX 79904
(915) 755-7697
(915) 751-1056
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/29/2021
Last updated
10/29/2021
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