Provider Demographics
NPI:1326264490
Name:KEY, TOMMY TRAVIS (DDS)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:TRAVIS
Last Name:KEY
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:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76068-0668
Mailing Address - Country:US
Mailing Address - Phone:940-325-9515
Mailing Address - Fax:940-325-9516
Practice Address - Street 1:917 E HUBBARD ST
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-5450
Practice Address - Country:US
Practice Address - Phone:940-325-9515
Practice Address - Fax:940-325-9516
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice