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Organization

DENTAL DEPOT OF INDEPENDENCE, PLLC

Active
Other names
Dental Depot of Independence, PLLC
Organization subpart
No

Provider details

NPI number
Authorized official
GAYLON ZISSA (DIRECTOR OF PROVIDER RELATIONS)
(405) 409-3789
Entity
Organization

Contact information

Practice address
16801 E US HIGHWAY 24, INDEPENDENCE, MO 64056-1529
(816) 750-1345
(816) 399-4615
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 945-8941
(405) 945-8959

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
06/21/2022
Last updated
06/21/2022
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