| Dental Depot Of Broken Arrow, Pllc | |
|
1950 W Kenosha St Broken Arrow OK 74012-8944 | |
| (405) 945-8941 | |
| (405) 945-8959 |
| Full Name | Dental Depot Of Broken Arrow, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1950 W Kenosha St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Glenn Allan 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 Broken Arrow, Pllc 2828 Nw 30th St Oklahoma City OK 73112-7404 Ph: (405) 945-8941 | Dental Depot Of Broken Arrow, Pllc 1950 W Kenosha St Broken Arrow OK 74012-8944 Ph: (405) 945-8941 |
| NPI Number | 1780001636 |
|---|---|
| Provider Enumeration Date | 03/27/2014 |
| Last Update Date | 06/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780001636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3723 (Oklahoma) | Primary |
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