Healthcare Provider Details

I. General information

NPI: 1629076500
Provider Name (Legal Business Name): CRAIG CAMERON HINE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S UTICA AVE
TULSA OK
74104-2641
US

IV. Provider business mailing address

602 S UTICA AVE
TULSA OK
74104-2641
US

V. Phone/Fax

Practice location:
  • Phone: 918-585-3744
  • Fax: 185-853-7749
Mailing address:
  • Phone: 918-585-3744
  • Fax: 918-585-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5256
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: