Provider Demographics
NPI:1316232218
Name:DICKEY, TRAVIS RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:RAYMOND
Last Name:DICKEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:69360-5111
Mailing Address - Country:US
Mailing Address - Phone:308-327-3141
Mailing Address - Fax:
Practice Address - Street 1:106 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NE
Practice Address - Zip Code:69360-5111
Practice Address - Country:US
Practice Address - Phone:308-327-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice