Healthcare Provider Details

I. General information

NPI: 1134336688
Provider Name (Legal Business Name): DENNIS W TRAMMELL, DMD, MSD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 WILLAMETTE ST STE B
EUGENE OR
97405-2847
US

IV. Provider business mailing address

2215 WILLAMETTE ST STE B
EUGENE OR
97405-2847
US

V. Phone/Fax

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

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: DR. DENNIS W TRAMMELL
Title or Position: SOLE PROPRIETOR
Credential: DMD, MSD
Phone: 541-345-3462