Provider Demographics
NPI:1134805401
Name:LUKE, TRAVIS HAROLD (DDS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:HAROLD
Last Name:LUKE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-3516
Mailing Address - Country:US
Mailing Address - Phone:509-941-3662
Mailing Address - Fax:
Practice Address - Street 1:1520 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-4921
Practice Address - Country:US
Practice Address - Phone:580-262-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77821223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice