# DALE K TRAVIS DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932203502
- **Authorized official:** DALE KENNETH TRAVIS DDS (DENTIST / OWNER)
- **Authorized official phone:** (425) 483-5959

## Contact information

- **Practice address:** 17416 135TH AVE NE, STE 201, WOODINVILLE, WA 98072
- **Practice address phone:** (425) 483-5959
- **Practice address fax:** (425) 806-5440
- **Mailing address:** PO BOX 606, WOODINVILLE, WA 98072
- **Mailing address phone:** (425) 483-5959
- **Mailing address fax:** (425) 806-5440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE00005037 | WA | — |
| 1223G0001X | General Practice Dentistry | DE00005037 | WA | Yes |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 06/01/2012