Dental Depot of 63Rd & NW Expressway, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DENTAL DEPOT OF 63RD & NW EXPRESSWAY, PLLC

Practice address

4025 NW 63Rd Street
Oklahoma City, OK 73116

Phone

(405) 591-3123

Fax

(405) 653-1714

NPI assigned

May 15, 2019

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, DDS

Title

Owner / President

Phone

(405) 591-3123

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1861058877",
    "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": "405-591-3123",
            "fax_number": "405-653-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 NW 63RD STREET",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73116",
            "telephone_number": "405-591-3123",
            "fax_number": "405-653-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DEPOT OF 63RD & NW EXPRESSWAY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-15",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "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": "405-591-3123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100088170A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "dentaldepot.net",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "4025 NW 63rd Street",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "73116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• 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 Jun 25, 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.