Healthcare Provider Details

I. General information

NPI: 1669746889
Provider Name (Legal Business Name): DR. GERALD W TRAMMELL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 FEDERAL BLVD STE 300
FEDERAL HEIGHTS CO
80260-8615
US

IV. Provider business mailing address

10350 FEDERAL BLVD STE 300
FEDERAL HEIGHTS CO
80260-8615
US

V. Phone/Fax

Practice location:
  • Phone: 303-865-7550
  • Fax: 303-427-9280
Mailing address:
  • Phone: 303-865-7550
  • Fax: 303-427-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6896
License Number StateCO

VIII. Authorized Official

Name: DR. GERALD W TRAMMELL
Title or Position: ORAL SURGEON
Credential: D.D.S
Phone: 303-865-7550