Provider Demographics
NPI:1538370234
Name:TRAVA, BRIAN P (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:TRAVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1961
Mailing Address - Country:US
Mailing Address - Phone:973-423-0789
Mailing Address - Fax:973-423-1188
Practice Address - Street 1:290 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1961
Practice Address - Country:US
Practice Address - Phone:973-423-0789
Practice Address - Fax:973-423-1188
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016566001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics