# DENTAL DEPOT OF 83RD & UNION HILLS PLLC

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

## Provider details

- **NPI number:** 1811642770
- **Authorized official:** GLENN A ASHMORE (OWNER / CEO)
- **Authorized official phone:** (405) 945-8941

## Contact information

- **Practice address:** 18855 N 83RD AVE, PEORIA, AZ 85382-2806
- **Practice address phone:** (623) 887-1123
- **Practice address fax:** (623) 278-0252
- **Mailing address:** 2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
- **Mailing address phone:** (623) 887-1123
- **Mailing address fax:** (623) 278-0252

## Taxonomy

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

## Other

- **Enumeration date:** 02/18/2022
- **Last updated:** 06/13/2025