Organization
DENTAL DEPOT 62ND & SOUTH WESTERN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN ALLEN ASHMORE DDS (PRESIDENT)
(405) 949-0123
Entity
Organization
Contact information
Practice address
6217 S WESTERN AVE, OKLAHOMA CITY, OK 73139-1605
(405) 606-7123
(405) 606-7130
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 606-7123
(405) 606-7130
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/19/2011
Last updated
06/25/2021
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