Organization
DENTAL DEPOT OF MESA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN A ASHMORE (OWNER / CEO)
(405) 945-8941
Entity
Organization
Contact information
Practice address
2311 W BROADWAY RD, MESA, AZ 85202-1005
(480) 571-3050
(480) 605-5013
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 945-8941
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/16/2021
Last updated
06/13/2025
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