Provider Demographics
NPI:1265569305
Name:TRAVIS, CARLYE ZAJICEK (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLYE
Middle Name:ZAJICEK
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12113 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3955
Mailing Address - Country:US
Mailing Address - Phone:402-571-0475
Mailing Address - Fax:402-571-2932
Practice Address - Street 1:12113 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3955
Practice Address - Country:US
Practice Address - Phone:402-571-0475
Practice Address - Fax:402-571-2932
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice