# DENTAL DEPOT OF LEES SUMMIT, PLLC

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

## Provider details

- **NPI number:** 1336828326
- **Authorized official:** GAYLON ZISSA (DIRECTOR OF PROVIDER RELATIONS)
- **Authorized official phone:** (405) 945-8941

## Contact information

- **Practice address:** 1501 NE RICE ROAD, LEES SUMMIT, MO 64086
- **Practice address phone:** (816) 402-3123
- **Mailing address:** 2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
- **Mailing address phone:** (405) 945-8941

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/17/2023
- **Last updated:** 07/17/2023