Provider Demographics
NPI:1164835039
Name:WALDING, TRAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:WALDING
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 1:2401 FOUNTAIN VIEW DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 FOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4827
Practice Address - Country:US
Practice Address - Phone:713-266-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29926OtherDENTAL LICENSE NUMBER