Provider Demographics
NPI:1205019825
Name:KENNETH GARNER, DDS, INC, PC
Entity Type:Organization
Organization Name:KENNETH GARNER, DDS, INC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-742-1480
Mailing Address - Street 1:3150 E 41ST ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3717
Mailing Address - Country:US
Mailing Address - Phone:918-742-1480
Mailing Address - Fax:918-742-1512
Practice Address - Street 1:3150 E 41ST ST
Practice Address - Street 2:SUITE #100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3717
Practice Address - Country:US
Practice Address - Phone:918-742-1480
Practice Address - Fax:918-742-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200002490 BMedicaid
OK200002490 AMedicaid