Provider Demographics
NPI:1295464980
Name:TRAVIS, ALEXANDRA ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 SHAKER BAY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1254
Mailing Address - Country:US
Mailing Address - Phone:518-810-2843
Mailing Address - Fax:
Practice Address - Street 1:1108 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2610
Practice Address - Country:US
Practice Address - Phone:518-370-1441
Practice Address - Fax:518-395-9431
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0637451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53099AOtherMEDICARE PIN
NY02995513Medicaid
NY331833OtherMEDICARE OSCAR