Healthcare Provider Details

I. General information

NPI: 1255526877
Provider Name (Legal Business Name): DR. CRAIG A. WOOTEN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 N MERIDIAN AVE BLDG 100 STE 101
OKLAHOMA CITY OK
73120-9369
US

IV. Provider business mailing address

13301 N MERIDIAN AVE BLDG 100 STE 101
OKLAHOMA CITY OK
73120-9369
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-7600
  • Fax:
Mailing address:
  • Phone: 405-751-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5181
License Number StateOK

VIII. Authorized Official

Name: CRAIG ALLEN WOOTEN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 405-751-7600