Provider Demographics
NPI:1104008861
Name:KERN, TRAVIS W (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:W
Last Name:KERN
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 49500
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-9500
Mailing Address - Country:US
Mailing Address - Phone:512-454-1220
Mailing Address - Fax:512-467-0363
Practice Address - Street 1:7800 MOPAC EXPWY
Practice Address - Street 2:SUITE 270
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-346-7949
Practice Address - Fax:512-346-9427
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244891223S0112X
TXN6417390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program