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General NPI Number Information
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NPI Number | 1649777343
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Entity Type | Individual
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Provider Name | KEITH TREVOR PASKETT DMD, MD, MBA
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Gender | Male
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 18001 N WESTERN AVE STE 106
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City | EDMOND
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State | OK
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Zip | 73012-9135
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Country | US
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Telephone | 405-256-3446
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Fax |
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Provider Business Mailing Address
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Address Line | 18001 N WESTERN AVE STE 106
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City | EDMOND
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State | OK
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Zip | 73012-9135
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Country | US
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Telephone | 405-256-3446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 245
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2025000173
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License Number State | MO
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