Provider Demographics
NPI:1861848152
Name:RAMMELL, PHELON (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHELON
Middle Name:
Last Name:RAMMELL
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 1:24837 TULIP AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3405
Mailing Address - Country:US
Mailing Address - Phone:253-278-8000
Mailing Address - Fax:
Practice Address - Street 1:24837 TULIP AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3405
Practice Address - Country:US
Practice Address - Phone:253-278-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308711223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist