=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881557593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGAVE ORAL SURGERY AND DENTAL IMPLANT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1646 N LITCHFIELD RD # B130
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85395-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-224-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1646 N LITCHFIELD RD # B130
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85395-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-224-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORAL & MAXILLOFACIAL SURGEON
-----------------------------------------------------
Name | DR. ERIC EDWARD SAIZ
-----------------------------------------------------
Credential | DMD, FACS
-----------------------------------------------------
Telephone | 623-224-8800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------