Dental Depot 62nd & South Western PLLC
Dentist, General Practice in Oklahoma City, OK. Organization (NPI-2).
NPI number1003196239
StatusActive
Last updated in NPPESJun 25, 2021
Details
- NPI
- 1003196239
- Entity type
- Organization (NPI-2)
- Legal business name
- Dental Depot 62nd & South Western PLLC
- Organization subpart
- No
- Enumeration date
- Aug 19, 2011
- Certification date
- Jun 25, 2021
- Last updated
- Jun 25, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
6217 S Western AveOklahoma City, OK 73139-1605
Phone 405-606-7123 · Fax 405-606-7130
Mailing address
2828 Nw 30th StOklahoma City, OK 73112-7404
Phone 405-606-7123 · Fax 405-606-7130
Authorized official
Glenn Allen Ashmore
President
4059490123
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