| Dental Depot South | |
|
1024 Sw 104th St Oklahoma City OK 73139-2990 | |
| (405) 691-1123 | |
| (405) 691-2674 |
| Full Name | Dental Depot South |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1024 Sw 104th St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Gaylon Zissa (DIRECTOR PROVIDER RELATIONS) |
| Authorized Official Contact | 4056911123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Depot South 2828 Nw 30th St Oklahoma City OK 73112-7404 Ph: (405) 691-1123 | Dental Depot South 1024 Sw 104th St Oklahoma City OK 73139-2990 Ph: (405) 691-1123 |
| NPI Number | 1578768180 |
|---|---|
| Provider Enumeration Date | 06/15/2007 |
| Last Update Date | 06/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578768180 | NPI | - | NPPES |
| 200100150A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Dental Works Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4200 Hemingway Dr, Oklahoma City, OK 73118 Phone: 405-557-1245 | |
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 | |
Gregory S. Shanbour, D.d.s., M.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8117 S Walker Ave, Oklahoma City, OK 73139 Phone: 405-634-2239 Fax: 405-634-3598 | |
Neighborhood Services Organization Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 431 Sw 11th Street, Oklahoma City, OK 73109 Phone: 405-236-0413 Fax: 405-236-1871 | |
Heather Cox Dds Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5701 N Portland Ave, Suite 121, Oklahoma City, OK 73112 Phone: 405-604-6400 Fax: 405-604-4229 | |
Dental Depot 62nd & South Western Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6217 S Western Ave, Oklahoma City, OK 73139 Phone: 405-606-7123 Fax: 405-606-7130 | |
Kelly Klontz Dds,pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 9721 S Pennsylvania Ave, Oklahoma City, OK 73159 Phone: 405-691-8100 |