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Organization
DENTAL DEPOT OF INDEPENDENCE, PLLC
Active
Organization
DENTAL DEPOT OF INDEPENDENCE, PLLC
Active
Other names
Dental Depot of Independence, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLON ZISSA (DIRECTOR OF PROVIDER RELATIONS)
(405) 409-3789
Entity
Organization
Contact information
Practice address
16801 E US HIGHWAY 24, INDEPENDENCE, MO 64056-1529
(816) 750-1345
(816) 399-4615
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 945-8941
(405) 945-8959
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/21/2022
Last updated
06/21/2022
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