Provider Demographics
NPI:1801694203
Name:TRAVIS LUKE, DDS, PLLC
Entity type:Organization
Organization Name:TRAVIS LUKE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-941-3662
Mailing Address - Street 1:4539 N 22ND ST STE R
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 E TALLAHASSEE DR
Practice Address - Street 2:
Practice Address - City:CORONA DE TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85641-2310
Practice Address - Country:US
Practice Address - Phone:520-762-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental