Individual
TRAVIS WAYNE SISCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
513 W CUMBERLAND ST, KINGSTON, TN 37763-2710
(865) 248-8361
Mailing address
201 ROSE RD, KINGSTON, TN 37763-3416
(931) 260-3028
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9481
TN
Other
Enumeration date
06/15/2012
Last updated
12/05/2012
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