Provider Demographics
NPI:1619384419
Name:MCALISTER, TRAVIS ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ANDREW
Last Name:MCALISTER
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 1:4455 HARRY WURZBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2402
Mailing Address - Country:US
Mailing Address - Phone:210-822-4664
Mailing Address - Fax:210-822-4878
Practice Address - Street 1:4455 HARRY WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2402
Practice Address - Country:US
Practice Address - Phone:210-822-4664
Practice Address - Fax:210-822-4878
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29921122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist