Provider Demographics
NPI:1437516077
Name:POINDEXTER, TRAVIS TOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:TOMAS
Last Name:POINDEXTER
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 1:705 W SANTA INEZ AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-7008
Mailing Address - Country:US
Mailing Address - Phone:650-348-1676
Mailing Address - Fax:
Practice Address - Street 1:705 W SANTA INEZ AVE
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:CA
Practice Address - Zip Code:94010-7008
Practice Address - Country:US
Practice Address - Phone:650-348-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist