Dental Depot Orthodontics Central Okc PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

6025 Issued in OK

Legal business name

DENTAL DEPOT ORTHODONTICS CENTRAL OKC PLLC

Practice address

4025 NW 63Rd St
Oklahoma City, OK 73116-1911

Phone

(405) 945-8940

NPI assigned

Jan 23, 2014

Organization subpart

Yes

Parent organization

GLENN A ASHMORE DDS INCAs reported in NPPES

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

Addresses

Part of

Dr Glenn a Ashmore Inc

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

{
    "created_epoch": "1390435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1790108900",
    "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": "4025 NW 63RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731161911",
            "telephone_number": "405-945-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DEPOT ORTHODONTICS CENTRAL OKC PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GLENN A ASHMORE DDS INC",
        "enumeration_date": "2014-01-23",
        "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": "6025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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 of Mustang, PLLC
• Dental Depot Orthodontics North Okc PLLC
• Dental Depot Orthodontics South PLLC
• Dental Depot Orthodontics SW Okc, PLLC
• Dental Depot South
• Dental Expressions

• Orthodontics and Dentofacial Orthopedics Dentistry in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Oklahoma

• 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.