Provider Demographics
NPI:1033649561
Name:DAVIS, TRAVIS ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ROBERT
Last Name:DAVIS
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 1:14910 SE WOODLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2743
Mailing Address - Country:US
Mailing Address - Phone:971-645-8068
Mailing Address - Fax:
Practice Address - Street 1:4309 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3971
Practice Address - Country:US
Practice Address - Phone:509-823-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60776469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist