Provider Demographics
NPI:1710240007
Name:MATTSON, TRAVIS CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:CHRISTIAN
Last Name:MATTSON
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 1:5011 SKYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7150
Mailing Address - Country:US
Mailing Address - Phone:231-947-3530
Mailing Address - Fax:231-947-2683
Practice Address - Street 1:5011 SKYVIEW CT
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7150
Practice Address - Country:US
Practice Address - Phone:231-947-3530
Practice Address - Fax:231-947-2683
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist