Healthcare Provider Details

I. General information

NPI: 1376420083
Provider Name (Legal Business Name): PALM TREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 KAYEN CHANDO STE 101
DEDEDO GU
96929-4906
US

IV. Provider business mailing address

144 KAYEN CHANDO STE 101
DEDEDO GU
96929-4906
US

V. Phone/Fax

Practice location:
  • Phone: 671-637-4867
  • Fax:
Mailing address:
  • Phone: 671-637-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ELIAS ABULENCIA
Title or Position: GENERAL MANAGER
Credential:
Phone: 671-788-1706