# DENTAL DEPOT 91ST & INDIAN SCHOOL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073204012
- **Authorized official:** DR. GLENN A ASHMORE (OWNER / CEO)
- **Authorized official phone:** (405) 945-8941

## Contact information

- **Practice address:** 4115 N. 91ST AVE., PHOENIX, AZ 85037
- **Practice address phone:** (623) 604-6723
- **Practice address fax:** (480) 741-8850
- **Mailing address:** 2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
- **Mailing address phone:** (405) 945-8941
- **Mailing address fax:** (405) 945-8959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/19/2023
- **Last updated:** 05/30/2025