Agave Dental Care North East, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

AGAVE DENTAL CARE NORTH EAST, PLLC

Practice address

8815 Dyer St Suite 210
El Paso, TX 79904

Phone

(915) 755-7697

Fax

(915) 751-1056

NPI assigned

Oct 29, 2021

Last updated

Oct 29, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jake Russell Williams, D.D.S.

Title

Owner/Dentist

Phone

(915) 755-7697

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1295499739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8815 DYER ST SUITE 210",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79904",
            "telephone_number": "915-755-7697",
            "fax_number": "915-751-1056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8815 DYER ST SUITE 210",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79904",
            "telephone_number": "915-755-7697",
            "fax_number": "915-751-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAVE DENTAL CARE NORTH EAST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-29",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JAKE",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "915-755-7697",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Olivia Ann Agee, MD
• Amirali Aghili

• General Practice Dentistry in El Paso, TX
• Providers in El Paso, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.