Provider Demographics
NPI:1144718008
Name:TRAVIS, DAVID BARTON JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BARTON
Last Name:TRAVIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4296
Mailing Address - Country:US
Mailing Address - Phone:731-642-3098
Mailing Address - Fax:
Practice Address - Street 1:715 MORTON ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4296
Practice Address - Country:US
Practice Address - Phone:731-642-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN107281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice