MEDICARE: AGAVE DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	F000375	AZ

General Provider Information

NPI Number	:	1851780852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAVE DENTAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 61025
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85082-1025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4235 N 32ND ST
Second Line	:	SUITE C
City	:	PHOENIX
State	:	AZ
Zip	:	85018-4766
Country	:	US
Telephone Number	:	602-957-2411
Fax Number	:

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MONICA DEWITT
Credential	:
Telephone Number	:	602-914-4274

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	05/22/2023

Similar Medicare Providers

1609875020 — BETH HAMANN D.D.S.
Practice Location Address:

4235 N 32ND ST , SUITE C
PHOENIX, AZ
85018-4766

Practice Phone: 602-957-2411
Practice Fax:

1316045990 — DR. K. CAROLYN HOGAN D.D.S.
Practice Location Address:

4235 N 32ND ST
PHOENIX, AZ
85018-4766

Practice Phone: 602-954-2451
Practice Fax: 602-954-8128

1811019565 — NEWSCAN IMAGING LLC
Practice Location Address:

4235 N 32ND ST , SUITE A
PHOENIX, AZ
85018-4766

Practice Phone: 602-808-9700
Practice Fax: 602-955-0680

1578954194 — AUSTROCYLINDROPUNTIA, LLC
Practice Location Address:

4235 N 32ND ST , SUITE A
PHOENIX, AZ
85018-4766

Practice Phone: 602-957-3808
Practice Fax: 602-957-3830

1215310461 — ELIZAVETA HAMANN DMD
Practice Location Address:

4235 N 32ND ST STE C
PHOENIX, AZ
85018-4766

Practice Phone: 602-957-2411
Practice Fax:

1841711579 — DR. KERI ANNE ABBOTT DDS
Practice Location Address:

4235 N 32ND ST
PHOENIX, AZ
85018-4766

Practice Phone: 602-610-0571
Practice Fax:

Directions to “AGAVE DENTAL LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.