Dental Depot Orthodontics Broken Arrow, Pllc
NPI #1508679598 in Broken Arrow, Oklahoma
Provider Information
- NPI Number
- 1508679598
- Entity Type
- Organization
- Organization Name
- Dental Depot Orthodontics Broken Arrow, Pllc
- Primary Specialty
- Dentist - Orthodontics and Dentofacial Orthopedics
- Enumeration Date
- Jan 31, 2025
- Last Updated
- Jan 31, 2025
Practice Location
- Address
- 1950 W KENOSHA ST STE B
- City
- Broken Arrow
- State
- Oklahoma
- ZIP Code
- 74012-8944
- Phone
- (539) 476-9588
Authorized Official
- Name
- GAYLON ZISSA
- Title
- DIRECTOR OF PROVIDER RELATIONS
- Phone
- (405) 945-8941
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics |
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