Provider Demographics
NPI:1033516232
Name:TRAMMELL, DENNIS WADE (DMD, MSD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:WADE
Last Name:TRAMMELL
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 WILLAMETTE ST. SUITE B
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-345-3462
Mailing Address - Fax:541-345-0658
Practice Address - Street 1:2215 WILLAMETTE ST. SUITE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2847
Practice Address - Country:US
Practice Address - Phone:541-345-3462
Practice Address - Fax:541-345-0658
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics