Provider Demographics
NPI:1366118242
Name:JEFFREY L TRAPNELL DDS PLLC
Entity type:Organization
Organization Name:JEFFREY L TRAPNELL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:3610 N UNIVERSITY AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4452
Mailing Address - Country:US
Mailing Address - Phone:801-344-8887
Mailing Address - Fax:801-344-8837
Practice Address - Street 1:3610 N UNIVERSITY AVE STE 175
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4452
Practice Address - Country:US
Practice Address - Phone:801-344-8887
Practice Address - Fax:801-344-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty