Dental Depot of del City, PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DENTAL DEPOT OF DEL CITY, PLLC

Practice address

5004 SE 29TH St
Del City, OK 73115-4710

Phone

(405) 477-8123

Fax

(405) 669-2850

NPI assigned

Jun 27, 2023

Last updated

Jun 27, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gaylon Zissa

Title

Director of Provider Relations

Phone

(405) 945-8941

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1205512779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5004 SE 29TH ST",
            "city": "DEL CITY",
            "state": "OK",
            "postal_code": "731154710",
            "telephone_number": "405-477-8123",
            "fax_number": "405-669-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5004 SE 29TH ST",
            "city": "DEL CITY",
            "state": "OK",
            "postal_code": "731154710",
            "telephone_number": "405-477-8123",
            "fax_number": "405-669-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DEPOT OF DEL CITY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A",
        "authorized_official_last_name": "ZISSA",
        "authorized_official_first_name": "GAYLON",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER RELATIONS",
        "authorized_official_telephone_number": "405-945-8941"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.dentaldepot.net",
            "affiliation": "N",
            "address_1": "5004 SE 29th St",
            "city": "Del City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731154710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Renee Davis, APRN-CNP
• David Evans De Gaston, M.D.
• Seana Dean, M.D.
• Deep Thoughts and Wellness Center
• Del City Nursing Center, LLC (Grace Living Center - del City)
• Dental Depot Orthodontics del City, PLLC
• Janet Kathryn Diehl, LPC
• Holly Dinh, PHARMD
• Steven Wayne Ditto, MD
• Tracy DO

• Dentist in Del City, OK
• Providers in Del City, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.