Provider Demographics
NPI:1306952734
Name:TRAVERS ORTHODONTICS PA
Entity type:Organization
Organization Name:TRAVERS ORTHODONTICS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:972-910-8202
Mailing Address - Street 1:1105 KINWEST PARKWAY
Mailing Address - Street 2:STE 105
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:972-910-8202
Mailing Address - Fax:972-910-8203
Practice Address - Street 1:1105 KINWEST PARKWAY
Practice Address - Street 2:STE 105
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:972-910-8202
Practice Address - Fax:972-910-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty