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Organization
DENTAL DEPOT OF ORTHODONTICS MESA, PLLC
Active
Organization
DENTAL DEPOT OF ORTHODONTICS MESA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLON ZISSA (DIRECTOR OF PROVIDER RELATIONS)
(405) 945-8941
Entity
Organization
Contact information
Practice address
2311 W BROADWAY RD STE B, MESA, AZ 85202-1005
(623) 352-0196
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(623) 352-0196
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
NULL
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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