# DENTAL DEPOT OF BROKEN ARROW, PLLC

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

## Provider details

- **NPI number:** 1780001636
- **Authorized official:** DR. GLENN ALLAN ASHMORE DDS (OWNER / PRESIDENT)
- **Authorized official phone:** (405) 949-0123

## Contact information

- **Practice address:** 1950 W KENOSHA ST, BROKEN ARROW, OK 74012-8944
- **Practice address phone:** (405) 945-8941
- **Practice address fax:** (405) 945-8959
- **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 |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3723 | OK | Yes |

## Other

- **Enumeration date:** 03/27/2014
- **Last updated:** 06/22/2021