| Dental Depot Of 10004 South Memorial Drive Pllc | |
|
1918 N. Drexel Oklahoma City OK 73107 | |
| (918) 209-5123 | |
| (918) 209-5124 |
| Full Name | Dental Depot Of 10004 South Memorial Drive Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1918 N. Drexel, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Glenn Allen Ashmore (OWNER/PRESIDENT) |
| Authorized Official Contact | 4059490123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Depot Of 10004 South Memorial Drive Pllc 2828 Nw 30th St Oklahoma City OK 73112-7404 Ph: (918) 209-5123 | Dental Depot Of 10004 South Memorial Drive Pllc 1918 N. Drexel Oklahoma City OK 73107 Ph: (918) 209-5123 |
| NPI Number | 1699028597 |
|---|---|
| Provider Enumeration Date | 10/17/2012 |
| Last Update Date | 06/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699028597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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