Provider Demographics
NPI:1154768299
Name:KITTELL, CAROLYN S (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:S
Last Name:KITTELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 FENWICK PL
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-6409
Mailing Address - Country:US
Mailing Address - Phone:405-210-7175
Mailing Address - Fax:
Practice Address - Street 1:1315 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5407
Practice Address - Country:US
Practice Address - Phone:405-354-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist