| NPI | 1447931803 |
|---|---|
| Doing Business As | DENTAL DEPOT OF POWER & BASELINE, PLLC |
| Entity Type | Organization |
| Authorized Contact | GAYLON ZISSA Director Of Provider Relations 405-945-8941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2023-07-28 |