Dental Depot of Mustang, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DENTAL DEPOT OF MUSTANG, PLLC

Practice address

2825 S Mustang Road
Oklahoma City, OK 73099

Phone

(405) 289-0123

NPI assigned

Mar 26, 2024

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

(918) 742-2123

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1679323182",
    "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": "918-742-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 S MUSTANG ROAD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73099",
            "telephone_number": "405-289-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DEPOT OF MUSTANG, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-22",
        "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": "918-742-2123"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Depot Hefner Station
• Dental Depot of 10004 South Memorial Drive PLLC
• Dental Depot of 145TH & N. Penn
• Dental Depot of 164TH & Portland PLLC
• Dental Depot of 63Rd & NW Expressway, PLLC
• Dental Depot Orthodontics Central Okc PLLC
• Dental Depot Orthodontics North Okc PLLC
• Dental Depot Orthodontics South PLLC
• Dental Depot Orthodontics SW Okc, PLLC
• Dental Depot South

• Dental Clinic/Center in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Dental Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; 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.