Dental Depot of Independence, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DENTAL DEPOT OF INDEPENDENCE, PLLC

Doing business as

Dental Depot of Independence, PLLC

Practice address

16801 E US Highway 24
Independence, MO 64056-1529

Phone

(816) 750-1345

Fax

(816) 399-4615

NPI assigned

Jun 21, 2022

Last updated

Jun 21, 2022By 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) 409-3789

Specialties & licenses 1

Addresses

Other names 1

• Dental Depot of Independence, PLLC Doing business as

Electronic endpoints 2

Locations

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655769600000",
    "number": "1568193449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 NW 30TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731127404",
            "telephone_number": "405-945-8941",
            "fax_number": "405-945-8959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16801 E US HIGHWAY 24",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640561529",
            "telephone_number": "816-750-1345",
            "fax_number": "816-399-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DEPOT OF INDEPENDENCE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-21",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "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": "405-409-3789"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "dentaldepot.net",
            "affiliation": "N",
            "address_1": "16801 E US Highway 24",
            "city": "Independence",
            "state": "MO",
            "country_code": "US",
            "postal_code": "640561529",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gzissa@dentaldepot.net",
            "affiliation": "N",
            "address_1": "16801 E US Highway 24",
            "city": "Independence",
            "state": "MO",
            "country_code": "US",
            "postal_code": "640561529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Dental Depot of Independence, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James P Demetriou, MD
• Jacquelyn Dennihan-Mulbah, PLMFT
• Audrey N Dennison, MSW, LMSW
• Dental Care Independence
• Dental Centers of Missouri J Warren Hildreth Jr DDS PC
• Todd Depaepe
• Alyssa Christine Deroos, M.S. CCC-SLP
• Meghnad C. Desai, M.D.
• Alyssa Deshay
• Developing Potential, Inc.

• Dental Clinic/Center in Independence, MO
• Providers in Independence, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; 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.