Provider Demographics
NPI:1669746889
Name:DR. GERALD W TRAMMELL P.C.
Entity type:Organization
Organization Name:DR. GERALD W TRAMMELL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-865-7550
Mailing Address - Street 1:10350 FEDERAL BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-8615
Mailing Address - Country:US
Mailing Address - Phone:303-865-7550
Mailing Address - Fax:303-427-9280
Practice Address - Street 1:10350 FEDERAL BLVD
Practice Address - Street 2:STE 300
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-8615
Practice Address - Country:US
Practice Address - Phone:303-865-7550
Practice Address - Fax:303-427-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty