Provider Demographics
NPI:1821097379
Name:TRAMMELL, CURTIS EVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:EVAN
Last Name:TRAMMELL
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 1:1857 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1907
Mailing Address - Country:US
Mailing Address - Phone:541-758-8500
Mailing Address - Fax:541-758-1498
Practice Address - Street 1:1857 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1907
Practice Address - Country:US
Practice Address - Phone:541-758-8500
Practice Address - Fax:541-758-1498
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-05-22
Provider Licenses
StateLicense IDTaxonomies
ORD70151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD7015OtherBOARD LICENSE