Organization Active NPI

Dental Depot Orthodontics North Okc PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Oklahoma City, OK
National Provider Identifier
1730502519
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
196 Issued in OK
Legal business name
DENTAL DEPOT ORTHODONTICS NORTH OKC PLLC
Practice address
14440 N Penn Ave
Oklahoma City, OK 73134-6003
Phone
(405) 748-3123
NPI assigned
Jan 29, 2014
Organization subpart
Yes
Parent organization
DENTAL DEPOT OF 145TH AND PENN PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Gaylon Zissa
Title
Director
Phone
(405) 945-8941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 196 OK Primary

Addresses

Primary practice location

14440 N Penn Ave
Oklahoma City, OK 73134-6003

Mailing address

2828 NW 30TH St
Oklahoma City, OK 73112-7404
Phone (405) 945-8941

National Provider Directory

National Provider Directory
Part of
Dental Depot of 145TH N Penn

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1390953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1730502519",
    "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": "14440 N PENN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731346003",
            "telephone_number": "405-748-3123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DEPOT ORTHODONTICS NORTH OKC PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL DEPOT OF 145TH AND PENN PLLC",
        "enumeration_date": "2014-01-29",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "ZISSA",
        "authorized_official_first_name": "GAYLON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "405-945-8941"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OK",
            "license": "196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.