| Dental Depot Southern Hills 71st & Jackson | |
|
710 W 71st St Tulsa OK 74132-1825 | |
| (918) 236-7123 | |
| (918) 998-0818 |
| Full Name | Dental Depot Southern Hills 71st & Jackson |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 710 W 71st St, Tulsa, Oklahoma |
| Authorized Official Name and Position | Glenn Allan Ashmore (OWNER / PRESIDENT) |
| Authorized Official Contact | 9182367123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Depot Southern Hills 71st & Jackson 2828 Nw 30th St Oklahoma City OK 73112-7404 Ph: (918) 236-7123 | Dental Depot Southern Hills 71st & Jackson 710 W 71st St Tulsa OK 74132-1825 Ph: (918) 236-7123 |
| NPI Number | 1407412992 |
|---|---|
| Provider Enumeration Date | 05/10/2019 |
| Last Update Date | 06/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407412992 | NPI | - | NPPES |
| 100088170A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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