Travis Cripps
Individual provider Active NPI Dentist · Whiteman Afb, MO
NPI 1104375575 · NPPES record last updated Sep 27, 2016
Key facts
- NPI
- 1104375575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019030225 (IL)
- Practice address
- 331 Sijen Ave
Whiteman Afb, MO 65305-1269 - Phone
- (660) 687-2201
- NPI assigned
- Sep 27, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190529003191 | MO | Order and Referring Only - Dentist |
1850634189 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019030225 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Little Egypt Pediatric Dentistry | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019030225 | IL | Yes |
Addresses
Primary practice location
331 Sijen Ave
Whiteman Afb, MO 65305-1269
Mailing address
331 Sijen Ave
Whiteman Afb, MO 65305-1269
Other providers in Whiteman Afb, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.