DENTAL DEPOT OF 10004 SOUTH MEMORIAL DRIVE PLLC (NPI# 1699028597) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699028597 |
| Entity Type | Organization |
| Organization Name | DENTAL DEPOT OF 10004 SOUTH MEMORIAL DRIVE PLLC |
| Practice Address |
1918 N. Drexel Oklahoma City OK 73107 |
| Mailing Address |
10004 South Memorial Drive East Tulsa OK 74133-6103 |
| Practice Telephone | 9182095123 |
| Practice Fax Number | 9182095124 |
| Mailing Telephone | 9182095123 |
| Mailing Fax Number | 9182095124 |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2013-04-12 |
| Authorized Official Name | DR. GLENN ALLEN ASHMORE (OWNER/PRESIDENT) |
| Authorized Official Telephone | 4059490123 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | Dental Providers |
| Street Address |
1918 N. DREXEL |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144747999 | Ellen Rose Pochyly | Counselor | 2617 General Pershing Boulevard, Oklahoma City, OK 73107 | 2017-08-23 |
| 1609399906 | Carrie Ann Moore | Counselor | 2617 General Pershing Blvd., Oklahoma City, OK 73107 | 2017-07-19 |
| 1821511320 | Diana Lynn Spencer | Counselor | 2617generalpershingblvd, Oklahoma City, OK 73107 | 2017-07-18 |
| 1861859514 | Catherine Evans | Counselor | 500 N Meridian Ave Ste 409, Oklahoma City, OK 73107 | 2016-01-26 |
| 1871964551 | Kizzy Frazier | Student in an Organized Health Care Education/Training Program | 1233 N Warren Pl, Oklahoma City, OK 73107 | 2015-10-07 |
| 1538550629 | Oklahoma Department of Mental Health and Substance Abuse | Case Management | 2625 General Pershing Boulevard, Oklahoma City, OK 73107 | 2015-02-10 |
| 1952702276 | Andale Healthcare, LLC | Clinic/Center | 2305 N. Meridian, Oklahoma City, OK 73107 | 2014-09-05 |
| 1114339348 | John Walls | Psychologist | 2012 North Villa Avenue, Oklahoma City, OK 73107 | 2014-05-22 |
| 1376970517 | Latrice Warrior | Community/Behavioral Health | 2625 General Pershing Drive, Oklahoma City, OK 73107 | 2013-10-02 |
| 1326485541 | Debra Sue Vaughan | Counselor | 2617 Genral Pershing Blvd, Oklahoma City, OK 73107 | 2013-05-29 |
| Find all providers in zip 73107 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447897749 | Hero Dental of South Oklahoma City | Dentist | 825 N Broadway Ave Ste 300, Oklahoma City, OK 73102-6012 | 2019-12-05 |
| 1356902126 | Adrienne Evelyn Wong | Dentist | 1200 Childrens Ave Ste 8f, Oklahoma City, OK 73104-4637 | 2019-06-24 |
| 1689133126 | Sdc Dental Practice of Ohio, LLC | Dentist | 7101 Nw 150th St Ste 100, Oklahoma City, OK 73142-9716 | 2019-03-14 |
| 1811483910 | Sarah Khyati | Dentist | 440 N Portland Ave # 1000, Oklahoma City, OK 73107-6110 | 2018-07-02 |
| 1881180974 | Hayden Fuller | Dentist | 1201 N Stonewall Ave # Dcsb253, Oklahoma City, OK 73117-1214 | 2018-07-02 |
| 1093206823 | Brian Bailey Howell | Dentist | 8200 Nw 106th Cir, Oklahoma City, OK 73162-8214 | 2018-05-29 |
| 1386135002 | Jeffrey Alan Scammahorn II | Dentist | 11317 S Western Ave Ste 500, Oklahoma City, OK 73170-5851 | 2018-05-29 |
| 1164936282 | Parkway Dental Group Pllc | Dentist | 3727 Nw 63rd St Ste 107, Oklahoma City, OK 73116-1923 | 2017-11-28 |
| 1225559404 | John Nathan Jacobsen | Dentist | 235 Sw 25th St., Oklahoma City, OK 73109 | 2017-06-28 |
| 1184154023 | Derek Ray Cohlmia | Dentist | 4301 Nw 63rd St Ste 303, Oklahoma City, OK 73116-1504 | 2017-06-14 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73107 |
Please comment or provide details below to improve the information on DENTAL DEPOT OF 10004 SOUTH MEMORIAL DRIVE PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.