Provider Demographics
NPI:1497020812
Name:OCHSNER, TRAVIS LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:LEE
Last Name:OCHSNER
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:USA DENTAL HEALTH ACTIVITY 4301 WILSON STREET
Mailing Address - Street 2:4301 WILSON STREET
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503
Mailing Address - Country:US
Mailing Address - Phone:580-442-5869
Mailing Address - Fax:
Practice Address - Street 1:COWAN DENTAL CLINIC 605 RANDOLPH RD.
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-442-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27633OtherTEXAS STATE DENTAL PROVIDER NUMBER