MEDICARE: TRAVIS HANEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D12024	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942380563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS HANEL DDS

Provider Business Mailing Address
First Line	:	205 W JOHNSON AVE
Second Line	:	STE. 3
City	:	WARREN
State	:	MN
Zip	:	56762-1118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W JOHNSON AVE
Second Line	:	STE 3
City	:	WARREN
State	:	MN
Zip	:	56762-1118
Country	:	US
Telephone Number	:	218-745-4601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	02/01/2013

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Directions to “ TRAVIS HANEL DDS” Practice Location

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