Healthcare Provider Details

I. General information

NPI: 1750584132
Provider Name (Legal Business Name): LENA RENEE CRAIG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LENA R OWENS DDS

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W CLAY AVE
COALGATE OK
74538-2030
US

IV. Provider business mailing address

405 W CLAY AVE
COALGATE OK
74538-2030
US

V. Phone/Fax

Practice location:
  • Phone: 580-927-2331
  • Fax: 580-927-2332
Mailing address:
  • Phone: 580-927-2331
  • Fax: 580-927-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5288
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: