MEDICARE: DR. TRAVIS R. CULLIMORE D.D.S.

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	5413	AZ

General Provider Information

NPI Number	:	1598886095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS R. CULLIMORE D.D.S.

Provider Business Mailing Address
First Line	:	908 W CHANDLER BLVD
Second Line	:	SUITE C-7
City	:	CHANDLER
State	:	AZ
Zip	:	85225-2548
Country	:	US
Telephone Number	:	480-782-8111
Fax Number	:	480-857-2609

Provider Business Practice Location Address
First Line	:	908 W CHANDLER BLVD
Second Line	:	SUITE C-7
City	:	CHANDLER
State	:	AZ
Zip	:	85225-2548
Country	:	US
Telephone Number	:	480-782-8111
Fax Number	:	480-857-2609

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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