Dental Depot Southern Hills 71st & Jackson
Clinic/Center, Dental in Tulsa, OK. Organization (NPI-2).
NPI number1407412992
StatusActive
Last updated in NPPESJun 25, 2021
Details
- NPI
- 1407412992
- Entity type
- Organization (NPI-2)
- Legal business name
- Dental Depot Southern Hills 71st & Jackson
- Organization subpart
- No
- Enumeration date
- May 10, 2019
- Certification date
- Jun 25, 2021
- Last updated
- Jun 25, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
710 W 71st StTulsa, OK 74132-1825
Phone 918-236-7123 · Fax 918-998-0818
Mailing address
2828 Nw 30th StOklahoma City, OK 73112-7404
Phone 918-236-7123 · Fax 918-998-0818
Authorized official
Glenn Allan Ashmore
Owner / President
9182367123
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