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General NPI Number Information
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NPI Number | 1932203502
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Entity Type | Organization
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Legal Business Name | DALE K TRAVIS DDS PS
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 17416 135TH AVE NE STE 201
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City | WOODINVILLE
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State | WA
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Zip | 98072
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Country | US
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Telephone | 425-483-5959
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Fax | 425-806-5440
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Provider Business Mailing Address
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Address Line | PO BOX 606
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City | WOODINVILLE
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State | WA
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Zip | 98072
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Country | US
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Telephone | 425-483-5959
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Fax | 425-806-5440
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | DALE KENNETH TRAVIS
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Credential | DDS
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Telephone | 425-483-5959
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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 | DE00005037
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00005037
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License Number State | WA
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