Dental Depot of Broken Arrow, PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

3723 Issued in OK

Legal business name

DENTAL DEPOT OF BROKEN ARROW, PLLC

Practice address

1950 W Kenosha St
Broken Arrow, OK 74012-8944

Phone

(405) 945-8941

Fax

(405) 945-8959

NPI assigned

Mar 27, 2014

Last updated

Jun 22, 2021By 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

Dr. Glenn Allan Ashmore, DDSNPI 1750379921

Title

Owner / President

Phone

(405) 949-0123

Specialties & licenses 1

Addresses

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.

• Glenn A Ashmore, DDS

  • General Practice Dentistry
  • Oklahoma City, OK
  • NPI 1750379921
  Authorized official Same address or phone

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1780001636",
    "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": "1950 W KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740128944",
            "telephone_number": "405-945-8941",
            "fax_number": "405-945-8959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DEPOT OF BROKEN ARROW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-27",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "ASHMORE",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "OWNER / PRESIDENT",
        "authorized_official_telephone_number": "405-949-0123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OK",
            "license": "3723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moriah Denise Deford
• Shannon Marie Delaney, DO
• Denis Savenko (Central Coast Medical Laboratory)
• James Denne
• Darlene A. Dennis, MSW
• Dental Depot Orthodontics Broken Arrow, PLLC
• Crystal Denton
• Dependacare Medical Equipment, Inc.
• Christina Derango, LPC CANDIDATE
• Haley M Derkach

• Dentist in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.