Provider Demographics
NPI:1548997703
Name:CARLYE TRAVIS DDS PC
Entity type:Organization
Organization Name:CARLYE TRAVIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLYE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-740-8026
Mailing Address - Street 1:12113 W CENTER RD STE 6
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3955
Mailing Address - Country:US
Mailing Address - Phone:402-571-0475
Mailing Address - Fax:402-571-2932
Practice Address - Street 1:12113 W CENTER RD STE 6
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3955
Practice Address - Country:US
Practice Address - Phone:402-571-0475
Practice Address - Fax:402-571-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental