Organization
VIC H. TRAMMELL DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA E SAMS (CONTRACT COORDINATOR)
(918) 494-8634
Entity
Organization
Contact information
Practice address
2950 S ELM PL, SUITE 340, BROKEN ARROW, OK 74012-7877
(918) 451-0944
(918) 455-8598
Mailing address
2950 S ELM PL, SUITE 340, BROKEN ARROW, OK 74012-7877
(918) 451-0944
(918) 455-8598
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4676
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100185040A
—
OK
Enumeration date
03/18/2010
Last updated
03/18/2010
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