Provider Demographics
NPI:1114624905
Name:AGAVE DENTAL PEBBLE HILLS PLLC
Entity Type:Organization
Organization Name:AGAVE DENTAL PEBBLE HILLS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HAVIG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-284-1338
Mailing Address - Street 1:11680 PEBBLE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1090
Mailing Address - Country:US
Mailing Address - Phone:915-225-4477
Mailing Address - Fax:915-225-4478
Practice Address - Street 1:11680 PEBBLE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1090
Practice Address - Country:US
Practice Address - Phone:915-225-4477
Practice Address - Fax:915-225-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty