Organization
DENTAL DEPOT SOUTHERN HILLS 71ST & JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN ALLAN ASHMORE DDS (OWNER / PRESIDENT)
(918) 236-7123
Entity
Organization
Contact information
Practice address
710 W 71ST ST, TULSA, OK 74132-1825
(918) 236-7123
(918) 998-0818
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(918) 236-7123
(918) 998-0818
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088170A
—
OK
Enumeration date
05/10/2019
Last updated
06/25/2021
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