Provider Demographics
NPI:1083944086
Name:BRIGGS-TRAMMELL, STAR MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:STAR
Middle Name:MARIE
Last Name:BRIGGS-TRAMMELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 LIBERTY RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5077
Mailing Address - Country:US
Mailing Address - Phone:503-363-4774
Mailing Address - Fax:
Practice Address - Street 1:1472 BARNICK RD NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-1708
Practice Address - Country:US
Practice Address - Phone:503-393-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4126124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist