Provider Demographics
NPI:1750584132
Name:CRAIG, LENA RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:RENEE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LENA
Other - Middle Name:R
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:405 W CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:COALGATE
Mailing Address - State:OK
Mailing Address - Zip Code:74538-2030
Mailing Address - Country:US
Mailing Address - Phone:580-927-2331
Mailing Address - Fax:580-927-2332
Practice Address - Street 1:405 W CLAY AVE
Practice Address - Street 2:
Practice Address - City:COALGATE
Practice Address - State:OK
Practice Address - Zip Code:74538-2030
Practice Address - Country:US
Practice Address - Phone:580-927-2331
Practice Address - Fax:580-927-2332
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1305288Medicaid