| Dental Depot Of 63rd & Nw Expressway, Pllc | |
|
4025 Nw 63rd Street Oklahoma City OK 73116 | |
| (405) 591-3123 | |
| (405) 653-1714 |
| Full Name | Dental Depot Of 63rd & Nw Expressway, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4025 Nw 63rd Street, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Glenn Allan Ashmore (OWNER / PRESIDENT) |
| Authorized Official Contact | 4055913123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Depot Of 63rd & Nw Expressway, Pllc 2828 Nw 30th St Oklahoma City OK 73112-7404 Ph: (405) 591-3123 | Dental Depot Of 63rd & Nw Expressway, Pllc 4025 Nw 63rd Street Oklahoma City OK 73116 Ph: (405) 591-3123 |
| NPI Number | 1861058877 |
|---|---|
| Provider Enumeration Date | 05/15/2019 |
| Last Update Date | 06/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861058877 | NPI | - | NPPES |
| 100088170A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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Wm Edward Holcomb Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6303 North Portland Ave #209, Oklahoma City, OK 73112 Phone: 405-942-7771 Fax: 405-942-7796 | |
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