Provider Demographics
NPI:1790879666
Name:VANTRAMP, ROLAND GERARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:GERARD
Last Name:VANTRAMP
Suffix:
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 1:600 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice