Provider Demographics
NPI:1629076500
Name:HINE, CRAIG CAMERON (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:CAMERON
Last Name:HINE
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 1:602 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-2641
Mailing Address - Country:US
Mailing Address - Phone:918-585-3744
Mailing Address - Fax:918-585-3774
Practice Address - Street 1:602 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-2641
Practice Address - Country:US
Practice Address - Phone:918-585-3744
Practice Address - Fax:185-853-7749
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100118870AMedicaid
OK100118870AMedicaid
959449OtherANTHEM BCBS