Travis Blake Rabun, DDS
Individual provider Active NPI Dentist · Fort Collins, CO
NPI 1457054876 · NPPES record last updated Jun 11, 2023
Key facts
- NPI
- 1457054876
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 00205593 (CO)
- Practice address
- 3506 Lochwood Dr
Fort Collins, CO 80525-2995 - Phone
- (720) 331-4401
- NPI assigned
- Mar 24, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00205593 | CO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Owens Dental Berthoud, P.C. | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 00205593 | CO | Yes |
Addresses
Primary practice location
3506 Lochwood Dr
Fort Collins, CO 80525-2995
Mailing address
3506 Lochwood Dr
Fort Collins, CO 80525-2995
Phone (720) 331-4401
Other practice location 1
2500 California Plz
Omaha, NE 68178-0002
Phone (402) 280-5990
Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.