Provider Demographics
NPI:1598920522
Name:WYMER, TRAVIS RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:RAY
Last Name:WYMER
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 1:4201 ANDERSON AVE
Mailing Address - Street 2:BLDG. A, SUITE 1
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7602
Mailing Address - Country:US
Mailing Address - Phone:785-537-4337
Mailing Address - Fax:785-539-4583
Practice Address - Street 1:4201 ANDERSON AVE
Practice Address - Street 2:BLDG. A, SUITE 1
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7602
Practice Address - Country:US
Practice Address - Phone:785-537-4337
Practice Address - Fax:785-539-4583
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist