Individual
DR. TRAVIS S HACKNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
615 W ALDER ST, SHELTON, WA 98584-3498
(360) 426-1676
Mailing address
PO BOX 398, SHELTON, WA 98584
(360) 426-1676
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00010321
WA
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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