Individual
TRAVIS ROYCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 12TH AVE RD STE 103, NAMPA, ID 83686-6185
(208) 467-9690
Mailing address
122 W OAK ST, CALDWELL, ID 83605-5147
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4245
ID
Other
Enumeration date
07/15/2009
Last updated
02/28/2013
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