Dental Depot of Owasso, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTAL DEPOT OF OWASSO, PLLC

Practice address

8722 N Garnett Road
Owasso, OK 74055

Phone

(918) 973-7123

Fax

(539) 208-3596

NPI assigned

May 1, 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

(405) 945-8941

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1714521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1881441699",
    "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": "918-973-7123",
            "fax_number": "539-208-3596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8722 N GARNETT ROAD",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "74055",
            "telephone_number": "918-973-7123",
            "fax_number": "539-208-3596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DEPOT OF OWASSO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-04-22",
        "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": "405-945-8941"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clayton David Dejarnett, D.O.
• Deborah Jean Dejarnett, DO
• Victoria Delaney, APRN
• Denise Johnson, OD,PLLC
• April Breanne Denney, PHARM.D
• Dental Professionals of Ok, PC
• Frank A Desandre Jr., M.D
• Amber Devilbiss
• Kenzie Devore
• Diagnostic Laboratory of Oklahoma LLC

• General Practice Dentistry in Owasso, OK
• Providers in Owasso, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.