Provider Demographics
NPI:1033313960
Name:TRAVIA, GERALYN (RDH)
Entity Type:Individual
Prefix:MS
First Name:GERALYN
Middle Name:
Last Name:TRAVIA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 N SWAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1800
Mailing Address - Country:US
Mailing Address - Phone:414-258-2216
Mailing Address - Fax:
Practice Address - Street 1:2669 N SWAN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1800
Practice Address - Country:US
Practice Address - Phone:414-258-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5674-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5674-016OtherDENTAL HYGIENIST