| NPI | 1073204012 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2023-05-19 |
| Last Updated | 2025-05-30 |
| Authorized Official | Glenn Ashmore Owner / CEO Phone: 4059458941 |
| Mailing Address | 2828 Nw 30th St Oklahoma City, OK 73112-7404 United States Phone: (405) 945-8941 | Fax: (405) 945-8959 📍 View Map |
| Primary Practice Address | 4115 N. 91st Ave. Phoenix, AZ 85037 United States Phone: (623) 604-6723 | Fax: (480) 741-8850 📍 View Map |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 1223G0001X – Dentist, General Practice | — | — |
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About NPI 1073204012
Dental Depot 91st & Indian School, Pllc is an organization registered in the CMS NPPES NPI Registry with NPI number 1073204012. The primary specialty listed is Dentist, General Practice. The organization is located in Phoenix, AZ. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2023-05-19. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1073204012?
NPI 1073204012 belongs to Dental Depot 91st & Indian School, Pllc, a Dentist, General Practice in Phoenix, AZ. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1073204012 active?
The current status of NPI 1073204012 in the NPPES registry is Active. The record was last updated on 2025-05-30.
What specialty is NPI 1073204012?
NPI 1073204012 is classified under the taxonomy Dentist, General Practice. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1073204012?
You can verify NPI 1073204012 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1073204012?
The primary practice address on file for NPI 1073204012 is 4115 N. 91st Ave., Phoenix, AZ 85037. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1073204012 issued?
NPI 1073204012 was first issued (enumerated) on 2023-05-19. The NPPES record was last updated on 2025-05-30.
Practice Location Map
Dental Depot 91st & Indian School, Pllc is located at 4115 N. 91st Ave., Phoenix, AZ. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Dental Depot 91st & Indian School, Pllc. All records sourced from the CMS NPPES registry.