Provider Demographics
NPI:1649777343
Name:PASKETT, KEITH TREVOR (DMD, MD, MBA)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:TREVOR
Last Name:PASKETT
Suffix:
Gender:M
Credentials:DMD, MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 N WESTERN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-9135
Mailing Address - Country:US
Mailing Address - Phone:405-256-3446
Mailing Address - Fax:
Practice Address - Street 1:18001 N WESTERN AVE STE 106
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9135
Practice Address - Country:US
Practice Address - Phone:405-256-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2451223S0112X
MO20250001731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery