Organization
DENTAL DEPOT ORTHODONTICS YUKON PLLC
Active
Parent organization
MT LINCOLN PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MT LINCOLN PLLC
Authorized official
GAYLON ZISSA (DIRECTOR)
(405) 945-8941
Entity
Organization
Contact information
Practice address
701 SHEDECK PKWY, YUKON, OK 73099-6021
(405) 350-1133
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 945-8941
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6025
OK
Other
Enumeration date
01/29/2014
Last updated
01/11/2024
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