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General NPI Number Information
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NPI Number | 1467755371
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Entity Type | Organization
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Legal Business Name | DENTAL DEPOT OF TULSA
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 2145 S SHERIDAN RD
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City | TULSA
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State | OK
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Zip | 74129-1001
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Country | US
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Telephone | 405-832-1123
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Fax | 405-601-5453
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Provider Business Mailing Address
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Address Line | 2828 NW 30TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7404
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Country | US
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Telephone | 405-832-1123
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Fax | 405-601-5453
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENN ALLEN ASHMORE
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Credential | DDS
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Telephone | 405-832-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3723
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License Number State | OK
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