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Organization
DENTAL DEPOT OF 63RD & NW EXPRESSWAY, PLLC
Active
Organization
DENTAL DEPOT OF 63RD & NW EXPRESSWAY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN ALLAN ASHMORE DDS (OWNER / PRESIDENT)
(405) 591-3123
Entity
Organization
Contact information
Practice address
4025 NW 63RD STREET, OKLAHOMA CITY, OK 73116
(405) 591-3123
(405) 653-1714
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 591-3123
(405) 653-1714
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
05/15/2019
Last updated
06/25/2021
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