Organization
DENTAL DEPOT OF ORTHODONTICS MESA, 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
2311 W BROADWAY RD STE B, MESA, AZ 85202-1005
(623) 352-0196
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(623) 352-0196
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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