Organization
DENTAL DEPOT ORTHODONTICS SOUTH PLLC
Active
Parent organization
DENTAL DEPOT WESTMINSTER VILLAGE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL DEPOT WESTMINSTER VILLAGE LLC
Authorized official
GAYLON ZISSA (DIRECTOR)
(405) 945-8941
Entity
Organization
Contact information
Practice address
1024 SW 104TH ST, OKLAHOMA CITY, OK 73139-2990
(405) 703-3527
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
73
OK
Other
Enumeration date
01/23/2014
Last updated
01/11/2024
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