Vic H. Trammell DMD, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4676 Issued in OK

Legal business name

VIC H. TRAMMELL DMD, PC

Practice address

2950 S Elm PL
Suite 340
Broken Arrow, OK 74012-7877

Phone

(918) 451-0944

Fax

(918) 455-8598

NPI assigned

Mar 18, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Julia E Sams

Title

Contract Coordinator

Phone

(918) 494-8634

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268870400000",
    "number": "1265756308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 S ELM PL",
            "address_2": "SUITE 340",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127877",
            "telephone_number": "918-451-0944",
            "fax_number": "918-455-8598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 S ELM PL",
            "address_2": "SUITE 340",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127877",
            "telephone_number": "918-451-0944",
            "fax_number": "918-455-8598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIC H. TRAMMELL DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-03-18",
        "status": "A",
        "authorized_official_last_name": "SAMS",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CONTRACT COORDINATOR",
        "authorized_official_telephone_number": "918-494-8634"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "4676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100185040A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.