Healthcare Provider Details

I. General information

NPI: 1033516232
Provider Name (Legal Business Name): DENNIS WADE TRAMMELL DMD, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 WILLAMETTE ST. SUITE B
EUGENE OR
97405-2847
US

IV. Provider business mailing address

2215 WILLAMETTE ST. SUITE B
EUGENE OR
97405
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-3462
  • Fax: 541-345-0658
Mailing address:
  • Phone: 541-345-3462
  • Fax: 541-345-0658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD6906
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: