Provider Demographics
NPI:1568637379
Name:CRAIG C HINE DDS PC
Entity type:Organization
Organization Name:CRAIG C HINE DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:HINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-364-4463
Mailing Address - Street 1:12345 S MEMORIAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2570
Mailing Address - Country:US
Mailing Address - Phone:918-364-4463
Mailing Address - Fax:918-682-8712
Practice Address - Street 1:12345 S MEMORIAL DR STE 103
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2570
Practice Address - Country:US
Practice Address - Phone:918-364-4463
Practice Address - Fax:918-682-8712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100118870AMedicaid