Provider Demographics
NPI:1235146895
Name:GARETSON, PAUL KENNETH (DDS4/29)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENNETH
Last Name:GARETSON
Suffix:
Gender:M
Credentials:DDS4/29
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N BROOKLINE AVE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3623
Mailing Address - Country:US
Mailing Address - Phone:405-948-7055
Mailing Address - Fax:405-949-0565
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-948-7055
Practice Address - Fax:405-949-0565
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice