Individual
BRENYATTA TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
6052 U S HIGHWAY 98, HATTIESBURG, MS 39402-8861
(601) 573-3760
(601) 914-4874
Mailing address
991 HIGHWAY 42, PETAL, MS 39465-9739
(601) 447-4799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4169-20
MS
Other
Enumeration date
10/07/2020
Last updated
07/18/2024
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