Provider Demographics
NPI:1487643367
Name:CHAPMAN, TRAVIS LANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:LANE
Last Name:CHAPMAN
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 1:501 PORTWAY AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1288
Mailing Address - Country:US
Mailing Address - Phone:541-436-2740
Mailing Address - Fax:888-224-2038
Practice Address - Street 1:501 PORTWAY AVENUE
Practice Address - Street 2:202
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031
Practice Address - Country:US
Practice Address - Phone:541-436-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2174122300000X
ORD98521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist