Organization
DENTAL DEPOT OF 10004 SOUTH MEMORIAL DRIVE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN ALLEN ASHMORE DDS (OWNER/PRESIDENT)
(405) 949-0123
Entity
Organization
Contact information
Practice address
1918 N. DREXEL, OKLAHOMA CITY, OK 73107
(918) 209-5123
(918) 209-5124
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(918) 209-5123
(918) 209-5124
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/17/2012
Last updated
06/25/2021
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