Individual
TRAVIS DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
24931 KELLY RD, EASTPOINTE, MI 48021-1384
(586) 771-0675
Mailing address
4829 NOTTINGHAM RD, DETROIT, MI 48224-3425
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
—
—
164W00000X
Licensed Practical Nurse
Primary
4703119474
MI
164X00000X
Licensed Vocational Nurse
4703119474
MI
2472R0900X
Renal Dialysis Technician
—
—
Other
Enumeration date
04/19/2021
Last updated
04/19/2021
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