| Dental Depot 91st & Indian School, Pllc | |
|
4115 N. 91st Ave. Phoenix AZ 85037 | |
| (623) 604-6723 | |
| (480) 741-8850 |
| Full Name | Dental Depot 91st & Indian School, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4115 N. 91st Ave., Phoenix, Arizona |
| Authorized Official Name and Position | Gaylon Zissa (DIRECTOR OF PROVIDER RELATIONS) |
| Authorized Official Contact | 4059458941 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Depot 91st & Indian School, Pllc 2828 Nw 30th St Oklahoma City OK 73112-7404 Ph: (405) 945-8941 | Dental Depot 91st & Indian School, Pllc 4115 N. 91st Ave. Phoenix AZ 85037 Ph: (623) 604-6723 |
| NPI Number | 1073204012 |
|---|---|
| Provider Enumeration Date | 05/19/2023 |
| Last Update Date | 05/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073204012 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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