Organization
DENTAL DEPOT OF 164TH & PORTLAND PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLON ZISSA (DIRECTOR OF PROVIDER RELATIONS)
(405) 409-3789
Entity
Organization
Contact information
Practice address
16401 IRONSTONE PLACE, OKLAHOMA CITY, OK 73013
(405) 900-7123
(405) 635-1252
Mailing address
16401 IRONSTONE PLACE, OKLAHOMA CITY, OK 73013
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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