Organization
AGAVE DENTAL FUN ZONE PLLC
Active
Other names
Dental Fun Zone
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY KASALLIS DDS (DENTIST)
(915) 833-0303
Entity
Organization
Contact information
Practice address
10501 GATEWAY BLVD W STE 107, EL PASO, TX 79925-7956
(915) 204-6941
Mailing address
6309 NATALICIO LN, EL PASO, TX 79912-1859
(915) 204-6941
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/11/2023
Last updated
01/11/2023
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