Dental Depot Of Blue Springs PLLC
Clinic/Center, Dental in Blue Springs, MO. Organization (NPI-2).
NPI number1164033122
StatusActive
Last updated in NPPESJun 25, 2021
Details
- NPI
- 1164033122
- Entity type
- Organization (NPI-2)
- Legal business name
- Dental Depot Of Blue Springs PLLC
- Organization subpart
- No
- Enumeration date
- Aug 13, 2020
- Certification date
- Jun 25, 2021
- Last updated
- Jun 25, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Dental Depot Of Blue Springs PLLC (Doing Business As)
Practice location
1500 S 7 HwyBlue Springs, MO 64014-3943
Phone 816-295-7927 · Fax 816-874-6812
Mailing address
2828 Nw 30th StOklahoma City, OK 73112-7404
Phone 816-295-7927 · Fax 816-874-6812
Authorized official
Gaylon Zissa
Professional Relations Manager
4059458941
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