Provider Demographics
NPI:1629151188
Name:EASTERN OKLAHOMA ORAL MAXILLOFACIAL SURGEONS
Entity type:Organization
Organization Name:EASTERN OKLAHOMA ORAL MAXILLOFACIAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:VIC
Authorized Official - Middle Name:HILL
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-451-0944
Mailing Address - Street 1:4716 W URBANA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5997
Mailing Address - Country:US
Mailing Address - Phone:918-449-5800
Mailing Address - Fax:918-455-8958
Practice Address - Street 1:2950 S ELM PLACE, SUITE 340
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:918-451-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty