Provider Demographics
NPI:1821178724
Name:HAMPTON, TRAVIS E (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:E
Last Name:HAMPTON
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 1:5229 HIGHWAY 278 NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2671
Mailing Address - Country:US
Mailing Address - Phone:770-784-7030
Mailing Address - Fax:770-784-1951
Practice Address - Street 1:5229 HIGHWAY 278 NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2671
Practice Address - Country:US
Practice Address - Phone:770-784-7030
Practice Address - Fax:770-784-1951
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice