MEDICARE: DENTAL DEPOT ORTHODONTICS CENTRAL OKC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6025	OK

General Provider Information

NPI Number	:	1790108900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL DEPOT ORTHODONTICS CENTRAL OKC PLLC

Provider Business Mailing Address
First Line	:	2828 NW 30TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7404
Country	:	US
Telephone Number	:	405-945-8941
Fax Number	:	405-945-8959

Provider Business Practice Location Address
First Line	:	4025 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1911
Country	:	US
Telephone Number	:	405-945-8940
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GAYLON ZISSA
Credential	:
Telephone Number	:	405-945-8941

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/11/2024

Similar Medicare Providers

1275888521 — ALFREDIA WILLIAMS
Practice Location Address:

5933 SE 68TH ST
OKLAHOMA CITY, OK
73135-1911

Practice Phone: 405-202-4234
Practice Fax:

1649221896 — DR. WILLIAM DYCUS PH.D.
Practice Location Address:

435 NW 19TH ST
OKLAHOMA CITY, OK
73103-1911

Practice Phone: 405-343-9407
Practice Fax:

1740576503 — MR. ERNEST E LONG
Practice Location Address:

2701 NE 19TH ST
OKLAHOMA CITY, OK
73111-1911

Practice Phone: 405-886-9161
Practice Fax:

1043598154 — ALLIED PHYSICIANS GROUP
Practice Location Address:

8014 N WESTERN AVE , SUITE E
OKLAHOMA CITY, OK
73114-1911

Practice Phone: 405-495-5154
Practice Fax:

1518333087 — PEACEFUL FAMILY SOLUTIONS INC
Practice Location Address:

7405 S DOUGLAS AVE
OKLAHOMA CITY, OK
73139-1911

Practice Phone: 405-601-2691
Practice Fax: 405-601-2773

1245924307 — ALONDRA JULIAN MITCHELL
Practice Location Address:

1911 NE GRAND BLVD
OKLAHOMA CITY, OK
73111-1825

Practice Phone: 405-977-6515
Practice Fax:

Directions to “DENTAL DEPOT ORTHODONTICS CENTRAL OKC PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.