Provider Demographics
NPI:1063891877
Name:TRAVIS M STORTS
Entity type:Organization
Organization Name:TRAVIS M STORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:STORTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-223-6720
Mailing Address - Street 1:1220 MERRICK DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1824
Mailing Address - Country:US
Mailing Address - Phone:580-223-6720
Mailing Address - Fax:580-223-6724
Practice Address - Street 1:1220 MERRICK DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1824
Practice Address - Country:US
Practice Address - Phone:580-223-6720
Practice Address - Fax:580-223-6724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty