DENTAL DEPOT SOUTHERN HILLS 71ST & JACKSON NPI 1407412992

NPI Information

NPI: 1407412992
Provider Name: DENTAL DEPOT SOUTHERN HILLS 71ST & JACKSON
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
710 W 71ST ST
TULSA, OK
ZIP 74132
Phone: (918) 236-7123
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DENTAL DEPOT SOUTHERN HILLS 71ST & JACKSON is a dental clinic center in Tulsa, OK. DENTAL DEPOT SOUTHERN HILLS 71ST & JACKSON NPI is 1407412992. The provider is registered as an organization entity type.

The provider's business location address is:

710 W 71ST ST
TULSA, OK
ZIP 74132-825
Phone: (918) 236-7123
Fax: (918) 998-0818

The provider's authorized official is Glenn Allan Ashmore .
The authorized official title is Owner / President and has the following contact phone number (918) 236-7123.

The enumeration date for this NPI number is 5/10/2019 and was last updated on 6/25/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100088170A	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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