Organization
DENTAL DEPOT ORTHODONTICS MOORE, 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
2709 S I 35 FRONTAGE RD STE A, MOORE, OK 73160-2715
(405) 957-5440
(405) 957-5542
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 945-8941
(405) 945-8959
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
01/31/2025
Last updated
01/31/2025
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