Provider Demographics
NPI:1689816407
Name:MICHAEL T. TRAMEL, D. D. S. P.A.
Entity Type:Organization
Organization Name:MICHAEL T. TRAMEL, D. D. S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-982-7212
Mailing Address - Street 1:2525 LAKEWARD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4827
Mailing Address - Country:US
Mailing Address - Phone:601-982-7212
Mailing Address - Fax:
Practice Address - Street 1:2525 LAKEWARD DR STE 102
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4827
Practice Address - Country:US
Practice Address - Phone:601-982-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS318301122300000X
MS2205851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty