Provider Demographics
NPI:1245597020
Name:ROSLYN TRAVIS STRATTON D.D.S.,P.C.
Entity Type:Organization
Organization Name:ROSLYN TRAVIS STRATTON D.D.S.,P.C.
Other - Org Name:MY DENTIST & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS-STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PC
Authorized Official - Phone:773-434-1515
Mailing Address - Street 1:2555 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1729
Mailing Address - Country:US
Mailing Address - Phone:773-434-1515
Mailing Address - Fax:773-434-1917
Practice Address - Street 1:2555 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1729
Practice Address - Country:US
Practice Address - Phone:773-434-1515
Practice Address - Fax:773-434-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190213921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty