Provider Demographics
NPI:1679651467
Name:CAMP, DENNIS ALAN (DPH)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ALAN
Last Name:CAMP
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:RATLIFF CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73481-0117
Mailing Address - Country:US
Mailing Address - Phone:580-856-3333
Mailing Address - Fax:580-856-3607
Practice Address - Street 1:1 MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:RATLIFF CITY
Practice Address - State:OK
Practice Address - Zip Code:73481-0117
Practice Address - Country:US
Practice Address - Phone:580-856-3333
Practice Address - Fax:580-856-3607
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371377OtherCAREMARK
OK8731400001-500OtherBLUE CROSS & BLUE SHIELD
OK8731400001-500OtherBLUE CROSS & BLUE SHIELD