Provider Demographics
NPI:1124018445
Name:TRIMMELL, LAWRENCE L (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:L
Last Name:TRIMMELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 E DOUGLAS AVE
Mailing Address - Street 2:#105
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2364
Mailing Address - Country:US
Mailing Address - Phone:316-686-6663
Mailing Address - Fax:316-686-9295
Practice Address - Street 1:8118 E DOUGLAS AVE
Practice Address - Street 2:#105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2364
Practice Address - Country:US
Practice Address - Phone:316-686-6663
Practice Address - Fax:316-686-9295
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS49541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics