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General NPI Number Information
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NPI Number | 1780791574
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Entity Type | Individual
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Provider Name | TRAVIS A RATLIFF DMD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 4159 N MAYO TRL SUITE 200, 203
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City | PIKEVILLE
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State | KY
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Zip | 41501-3211
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Country | US
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Telephone | 606-432-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 2037 STONE COAL RD
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City | PIKEVILLE
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State | KY
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Zip | 41501-5720
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Country | US
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Telephone | 606-437-2372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410743
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8549
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License Number State | KY
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