=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982559480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM TREE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2026
-----------------------------------------------------
Last Update Date | 02/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 KAYEN CHANDO STE 101
-----------------------------------------------------
City | DEDEDO
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96929-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 671-637-4867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20638
-----------------------------------------------------
City | BARRIGADA
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96921-0638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL MANAGER
-----------------------------------------------------
Name | ELIAS ABULENCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 671-788-1706
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------