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Individual

DR. GRADEN TRUMBLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS, MS

Contact information

Practice address
2029 VALLEYGATE DR STE 201, FAYETTEVILLE, NC 28304-3772
(910) 885-2451
Mailing address
2035 E TETON BLVD, GREEN RIVER, WY 82935-6237
(307) 871-5413

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1504
WY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12157
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12157
NORTH CAROLINA DENTAL LICENSE
NC
01
1504
WYOMING DENTAL LICENSE
WY
Enumeration date
04/01/2020
Last updated
11/23/2021
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