Organization
DENTAL DEPOT ORTHODONTICS TECUMSEH, 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
3401 W TECUMSEH RD STE B, NORMAN, OK 73072-1809
(405) 402-4554
(405) 292-4180
Mailing address
2828 NW 30TH ST, OKLAHOMA CITY, OK 73112-7404
(405) 402-4554
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
09/21/2022
Last updated
09/21/2022
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