Provider Demographics
NPI:1073670550
Name:AUSTIN, TRAVIS JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:JAMES
Last Name:AUSTIN
Suffix:
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 1:3635 AYRSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8606
Mailing Address - Country:US
Mailing Address - Phone:210-535-7705
Mailing Address - Fax:
Practice Address - Street 1:1325 PINE ST STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3189
Practice Address - Country:US
Practice Address - Phone:321-725-5377
Practice Address - Fax:321-951-3393
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360321223G0001X, 1223S0112X
GADN0155421223S0112X
SC90481223S0112X
FLDN277841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice