Provider Demographics
NPI:1285832774
Name:TRAVELLE, DANIEL PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PATRICK
Last Name:TRAVELLE
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 1:1808 12TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2908
Mailing Address - Country:US
Mailing Address - Phone:480-319-2818
Mailing Address - Fax:
Practice Address - Street 1:19723 HIGHWAY 99
Practice Address - Street 2:SUITE A
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6051
Practice Address - Country:US
Practice Address - Phone:425-775-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7294122300000X
WADE60219557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist