Provider Demographics
NPI:1013330885
Name:DENTAL DEPOT ORTHODONTICS NORMAN PLLC
Entity Type:Organization
Organization Name:DENTAL DEPOT ORTHODONTICS NORMAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:POGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-945-8941
Mailing Address - Street 1:1920 N DREXEL BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3925
Mailing Address - Country:US
Mailing Address - Phone:405-945-8941
Mailing Address - Fax:405-945-8959
Practice Address - Street 1:701 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6918
Practice Address - Country:US
Practice Address - Phone:405-310-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL DEPOT OF NORMAN PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty