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General NPI Number Information
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NPI Number | 1245597020
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Entity Type | Organization
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Legal Business Name | ROSLYN TRAVIS STRATTON D.D.S.,P.C.
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 2555 W 79TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-1729
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Country | US
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Telephone | 773-434-1515
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Fax | 773-434-1917
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Provider Business Mailing Address
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Address Line | 2555 W 79TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-1729
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Country | US
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Telephone | 773-434-1515
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Fax | 773-434-1917
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. ROSLYN TRAVIS-STRATTON
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Credential | D.D.S.,P.C.
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Telephone | 773-434-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019021392
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License Number State | IL
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