Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D6906 | OR |
NPI | 1033516232 |
---|---|
Provider Name | Dennis Wade Trammell |
First Address | Eugene, OR 97405 |
Second Address | Eugene, OR 97405-2847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2014 |
Last Update Date | 03/12/2014 |