Provider Demographics
NPI:1801060751
Name:STEPHEN W GARDER
Entity type:Organization
Organization Name:STEPHEN W GARDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GARDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-799-5529
Mailing Address - Street 1:808 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6302
Mailing Address - Country:US
Mailing Address - Phone:405-799-5529
Mailing Address - Fax:405-799-8223
Practice Address - Street 1:808 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6302
Practice Address - Country:US
Practice Address - Phone:405-799-5529
Practice Address - Fax:405-799-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty