Provider Demographics
NPI:1053549014
Name:CAMPBELL, KRISTEN RENEE' WOLEVER (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:RENEE' WOLEVER
Last Name:CAMPBELL
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 1:420 24TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5110
Mailing Address - Country:US
Mailing Address - Phone:405-329-6603
Mailing Address - Fax:
Practice Address - Street 1:420 24TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1214
Practice Address - Country:US
Practice Address - Phone:405-329-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist