Provider Demographics
NPI:1396846325
Name:TRAMMELL, ANDREW ELLISON JR (DMD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ELLISON
Last Name:TRAMMELL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505
Mailing Address - Country:US
Mailing Address - Phone:850-477-5252
Mailing Address - Fax:850-477-5532
Practice Address - Street 1:151 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505
Practice Address - Country:US
Practice Address - Phone:850-477-5252
Practice Address - Fax:850-477-5532
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLDN15507122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist