DENTAL DEPOT OF 63RD & NW EXPRESSWAY, PLLC (NPI# 1861058877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861058877 |
| Entity Type | Organization |
| Organization Name | DENTAL DEPOT OF 63RD & NW EXPRESSWAY, PLLC |
| Practice Address |
4025 Nw 63rd Street Oklahoma City OK 73116 |
| Practice Telephone | 4055913123 |
| Practice Fax Number | 4056531714 |
| Mailing Telephone | 4055913123 |
| Mailing Fax Number | 4056531714 |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2019-05-15 |
| Authorized Official Name | DR. GLENN ALLAN ASHMORE (OWNER / PRESIDENT) |
| Authorized Official Telephone | 4055913123 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100088170A | 05 |
| Street Address |
4025 NW 63RD STREET |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306455068 | Restore Family Counseling, LLC | Clinic/Center | 100 W. Wilshire, Suite #c3, Oklahoma City, OK 73116 | 2020-07-29 |
| 1073001756 | Oklahoma Clinical Management LLC | Prevention Professional | 4301 Nw 63rd St Ste 107, Oklahoma City, OK 73116 | 2018-04-27 |
| 1235658261 | Heinen Physical Therapy, PC | Clinic/Center | 7710 N May Ave, Oklahoma City, OK 73116 | 2017-09-11 |
| 1235657842 | Jacque S Komers | Counselor | 6501 N Broadway Ext Suite 180, Oklahoma City, OK 73116 | 2017-09-04 |
| 1164943874 | Jo Ann Cole-johnson | Counselor | 6505 N. Shawnee Ave, Oklahoma, OK 73116 | 2017-07-03 |
| 1548790793 | Zachary Wayne Skates | Case Manager/Care Coordinator | North 6501 Broadway Extention Highway #180, Oklahoma City, OK 73116 | 2017-06-19 |
| 1548622673 | Jessica Defiore | Case Manager/Care Coordinator | 6501 N Broadway Extension, Oklahoma City, OK 73116 | 2016-03-28 |
| 1093173247 | Patrice Ann Cook | Specialist/Technologist, Other | 7700 N. Hudson Ave, Suite Number 9, Oklahoma City, OK 73116 | 2016-02-03 |
| 1467880708 | Abrina Marie Kneeland | Occupational Therapy Assistant | 6525 N. Meridian #311, Therapists Unlimited Division of Career Staff, Oklahoma City, OK 73116 | 2013-10-24 |
| 1538591649 | Lauren Collier Peterson | Physical Therapist | 7415 N May Ave, Oklahoma City, OK 73116 | 2013-07-31 |
| Find all providers in zip 73116 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063041275 | Fleming Dental Co Pllc | Clinic/Center | 13316 S Western Ave Ste B, Oklahoma City, OK 73170-7309 | 2020-04-08 |
| 1578103743 | Dental Surgery Center of Midwest City | Clinic/Center | 9060 Harmony Dr Ste E, Oklahoma City, OK 73130-6253 | 2020-01-15 |
| 1053959247 | Phillip J Elassal Dds Pllc | Clinic/Center | 1601 Sw 89th Street #g500, Oklahoma City, OK 73159 | 2019-12-18 |
| 1558902874 | Insight Dental and Implants | Clinic/Center | 3906 Nw 10th St Ste B, Oklahoma City, OK 73107-6060 | 2019-10-08 |
| 1225683311 | I240 Dental | Clinic/Center | 1506 W I 240 Service Rd, Oklahoma City, OK 73159-4126 | 2019-08-06 |
| 1285100339 | Moore Dentistry & Braces | Clinic/Center | 1530 Sw 119th St Unit 108, Oklahoma City, OK 73170-4938 | 2018-10-16 |
| 1295254068 | Sih Oklahoma PC | Clinic/Center | 1325 N Walker Ave 547, Oklahoma City, OK 73103-6405 | 2017-09-13 |
| 1851811293 | Red Dirt Orthodontics Pllc | Clinic/Center | 5940 Nw Expressway # 100, Oklahoma City, OK 73132-5101 | 2017-06-27 |
| 1518494384 | Uptown Smiles Pllc | Clinic/Center | 601 Nw 23rd St, Suite 200, Oklahoma City, OK 73103-1415 | 2017-05-11 |
| 1518250265 | Legacy Family Dentist, Pllc. | Clinic/Center | 8470 Nw Expressway, Oklahoma City, OK 73162-6009 | 2011-05-26 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73116 |
Please comment or provide details below to improve the information on DENTAL DEPOT OF 63RD & NW EXPRESSWAY, 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.