Provider Demographics
NPI:1568477271
Name:DIETERLEN, BRETT BUCHANAN (DDS,BS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:BUCHANAN
Last Name:DIETERLEN
Suffix:
Gender:M
Credentials:DDS,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 E 107TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-6602
Mailing Address - Country:US
Mailing Address - Phone:918-299-3523
Mailing Address - Fax:918-299-7527
Practice Address - Street 1:3015 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3324
Practice Address - Country:US
Practice Address - Phone:918-299-2400
Practice Address - Fax:918-299-0135
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist