Organization
DENTAL DEPOT OF MUSTANG, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLON ZISSA (DIRECTOR OF PROVIDER RELATIONS)
(918) 742-2123
Entity
Organization
Contact information
Practice address
2825 S MUSTANG ROAD, OKLAHOMA CITY, OK 73099
(405) 289-0123
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(918) 742-2123
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/26/2024
Last updated
03/26/2024
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