Provider Demographics
NPI:1336147404
Name:TRAMMELL, GERALD W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
Last Name:TRAMMELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9462 FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5826
Mailing Address - Country:US
Mailing Address - Phone:303-865-7550
Mailing Address - Fax:303-427-9280
Practice Address - Street 1:9462 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-5826
Practice Address - Country:US
Practice Address - Phone:303-865-7550
Practice Address - Fax:303-427-9280
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CO68961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery