Organization
DENTAL DEPOT OF OWASSO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLON ZISSA (DIRECTOR OF PROVIDER RELATIONS)
(405) 945-8941
Entity
Organization
Contact information
Practice address
8722 N GARNETT ROAD, OWASSO, OK 74055
(918) 973-7123
(539) 208-3596
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(918) 973-7123
(539) 208-3596
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
05/01/2024
Last updated
05/01/2024
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