Organization
DENTAL DEPOT OF BROKEN ARROW, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN ALLAN ASHMORE DDS (OWNER / PRESIDENT)
(405) 949-0123
Entity
Organization
Contact information
Practice address
1950 W KENOSHA ST, BROKEN ARROW, OK 74012-8944
(405) 945-8941
(405) 945-8959
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 945-8941
(405) 945-8959
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3723
OK
Other
Enumeration date
03/27/2014
Last updated
06/22/2021
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