| NPI | 1568193449 |
|---|---|
| Doing Business As | DENTAL DEPOT OF INDEPENDENCE, PLLC |
| Entity Type | Organization |
| Authorized Contact | GAYLON ZISSA Director Of Provider Relations 405-409-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2022-06-21 |