Organization
DENTAL DEPOT ORTHODONTICS MOORE, PLLC
Active
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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