| Dental Depot Of 164th & Portland Pllc | |
|
16401 Ironstone Place Oklahoma City OK 73013 | |
| (405) 900-7123 | |
| (405) 635-1252 |
| Full Name | Dental Depot Of 164th & Portland Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 16401 Ironstone Place, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Gaylon Zissa (DIRECTOR OF PROVIDER RELATIONS) |
| Authorized Official Contact | 4054093789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Depot Of 164th & Portland Pllc 16401 Ironstone Place Oklahoma City OK 73013 Ph: () - | Dental Depot Of 164th & Portland Pllc 16401 Ironstone Place Oklahoma City OK 73013 Ph: (405) 900-7123 |
| NPI Number | 1639895402 |
|---|---|
| Provider Enumeration Date | 10/13/2022 |
| Last Update Date | 10/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639895402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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