Provider Demographics
NPI:1487988580
Name:TRAVELLE, KATHLEEN MCKAY (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MCKAY
Last Name:TRAVELLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:LINDSAY
Other - Last Name:MCKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1529 S TIMESQUARE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-8266
Mailing Address - Country:US
Mailing Address - Phone:208-314-1901
Mailing Address - Fax:
Practice Address - Street 1:1529 S TIMESQUARE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8266
Practice Address - Country:US
Practice Address - Phone:208-314-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60106324122300000X
IDD-56101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist