Organization
AGAVE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA DEWITT (OFFICE ADMINISTRATOR)
(602) 914-4274
Entity
Organization
Contact information
Practice address
4235 N 32ND ST, SUITE C, PHOENIX, AZ 85018-4766
(602) 957-2411
Mailing address
PO BOX 61025, PHOENIX, AZ 85082-1025
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
F000375
AZ
Other
Enumeration date
01/13/2015
Last updated
05/22/2023
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