Dental Depot of Broken Arrow, Pllc
NPI #1780001636 in Broken Arrow, Oklahoma
Provider Information
- NPI Number
- 1780001636
- Entity Type
- Organization
- Organization Name
- Dental Depot of Broken Arrow, Pllc
- Primary Specialty
- Dentist
- Enumeration Date
- Mar 27, 2014
- Last Updated
- Jun 22, 2021
Practice Location
- Address
- 1950 W KENOSHA ST
- City
- Broken Arrow
- State
- Oklahoma
- ZIP Code
- 74012-8944
- Phone
- (405) 945-8941
Authorized Official
- Name
- DR. GLENN ALLAN ASHMORE, DDS
- Title
- OWNER / PRESIDENT
- Phone
- (405) 949-0123
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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