Provider Demographics
NPI:1992860415
Name:KIRKLAND, TRAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:KIRKLAND
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 1:2575 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2468
Mailing Address - Country:US
Mailing Address - Phone:775-738-9666
Mailing Address - Fax:775-738-6815
Practice Address - Street 1:2575 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2468
Practice Address - Country:US
Practice Address - Phone:775-738-9666
Practice Address - Fax:775-738-6815
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV41671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502132Medicaid