Individual
JILLIAN MARIE TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1213 W NISHNA RD, SHENANDOAH, IA 51601-2115
(712) 246-2180
(712) 246-1683
Mailing address
1204 W SHERIDAN AVE, SHENANDOAH, IA 51601-1554
(712) 246-2180
(712) 246-1683
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
5587
IA
124Q00000X
Dental Hygienist
Primary
2062
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0062240
—
IA
01
—
1306926407
NPI
IA
Enumeration date
12/21/2010
Last updated
05/20/2019
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