Provider Demographics
NPI:1790079531
Name:SCHULLER, TRAVIS ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ROBERT
Last Name:SCHULLER
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0092
Mailing Address - Country:US
Mailing Address - Phone:541-620-4577
Mailing Address - Fax:
Practice Address - Street 1:2381 NE CONNERS AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6068
Practice Address - Country:US
Practice Address - Phone:541-837-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice