Organization · NPI-2
Dental Depot Orthodontics 83rd And Union Hills, PLLC
Clinic/Center, Dental · Peoria, AZ
NPI number1396586400
StatusActive
Last updated in NPPESJun 3, 2024
Details
- NPI
- 1396586400
- Entity type
- Organization (NPI-2)
- Legal business name
- Dental Depot Orthodontics 83rd And Union Hills, PLLC
- Organization subpart
- No
- Enumeration date
- Jun 3, 2024
- Certification date
- Jun 3, 2024
- Last updated
- Jun 3, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
| 261Q00000X | Clinic/Center | – | – |
Practice location
18855 N 83rd Ave Ste BPeoria, AZ 85382-2806
Phone 623-352-0195
Mailing address
2828 Nw 30th StOklahoma City, OK 73112-7404
Phone 623-267-4129
Authorized official
Gaylon Zissa
Director Of Provider Relations
4059458941
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