Provider Demographics
NPI:1760507321
Name:ROLAND G. VANTRAMP, D.M.D.,P.S.
Entity Type:Organization
Organization Name:ROLAND G. VANTRAMP, D.M.D.,P.S.
Other - Org Name:DOVE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:VANTRAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-770-2777
Mailing Address - Street 1:600 39TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5900
Mailing Address - Country:US
Mailing Address - Phone:253-770-2777
Mailing Address - Fax:253-770-2783
Practice Address - Street 1:600 39TH AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5900
Practice Address - Country:US
Practice Address - Phone:253-770-2777
Practice Address - Fax:253-770-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty