Provider Demographics
NPI:1053850248
Name:TRAVERS, KIMBERLY (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 KINWEST PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3428
Mailing Address - Country:US
Mailing Address - Phone:972-910-8202
Mailing Address - Fax:972-910-8203
Practice Address - Street 1:1105 KINWEST PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3428
Practice Address - Country:US
Practice Address - Phone:972-910-8202
Practice Address - Fax:972-910-8203
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306952734OtherNPI TYPE II FOR TRAVERS ORTHODONTICS PA