Provider Demographics
NPI:1053204578
Name:GAYTAN, BLAS EDUARDO (DDS)
Entity type:Individual
Prefix:DR
First Name:BLAS
Middle Name:EDUARDO
Last Name:GAYTAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N BLACKWELDER AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-2266
Mailing Address - Country:US
Mailing Address - Phone:918-939-8152
Mailing Address - Fax:
Practice Address - Street 1:701 SHEDECK PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6021
Practice Address - Country:US
Practice Address - Phone:918-939-8152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist