Provider Demographics
NPI:1265873806
Name:DANIEL TRAVELLE DDS AND KATHLEEN TRAVELLE DDS, PLLC
Entity type:Organization
Organization Name:DANIEL TRAVELLE DDS AND KATHLEEN TRAVELLE DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:TRAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-643-3191
Mailing Address - Street 1:115 S 177TH PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1782
Mailing Address - Country:US
Mailing Address - Phone:206-242-1500
Mailing Address - Fax:
Practice Address - Street 1:115 S 177TH PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98148-1782
Practice Address - Country:US
Practice Address - Phone:206-242-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60219557261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental