Provider Demographics
NPI:1306858485
Name:TRAMMELL, CALVIN DWAYNE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:DWAYNE
Last Name:TRAMMELL
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 N JOSEY LN
Mailing Address - Street 2:#126
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2482
Mailing Address - Country:US
Mailing Address - Phone:972-492-3386
Mailing Address - Fax:972-492-4038
Practice Address - Street 1:3730 N JOSEY LN
Practice Address - Street 2:#126
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2482
Practice Address - Country:US
Practice Address - Phone:972-492-3386
Practice Address - Fax:972-492-4038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213168510Medicaid
TX213168503Medicaid
TX213168504Medicaid
TX213168505Medicaid
TX213168507Medicaid
TX213168508Medicaid
TX213168506Medicaid