Provider Demographics
NPI:1831290378
Name:ROBERTS, TRAVIS ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ANDREW
Last Name:ROBERTS
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 1:2119 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-4145
Mailing Address - Country:US
Mailing Address - Phone:913-621-3113
Mailing Address - Fax:913-621-0004
Practice Address - Street 1:2119 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-4145
Practice Address - Country:US
Practice Address - Phone:913-621-3113
Practice Address - Fax:913-621-0004
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS68951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice