Provider Demographics
NPI:1649719246
Name:TRAVIS ROTTMAN DDS PLLC
Entity type:Organization
Organization Name:TRAVIS ROTTMAN DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ROTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-533-2468
Mailing Address - Street 1:310 GRAND HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5081
Mailing Address - Country:US
Mailing Address - Phone:214-533-2468
Mailing Address - Fax:
Practice Address - Street 1:8040 WOODBRIDGE PARKWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048
Practice Address - Country:US
Practice Address - Phone:214-533-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27987261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental