Provider Demographics
NPI:1821251513
Name:EPPERSON, TRAVIS LANE (DDS)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LANE
Last Name:EPPERSON
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 1:8220 MEMPHIS AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2612
Mailing Address - Country:US
Mailing Address - Phone:806-687-1000
Mailing Address - Fax:
Practice Address - Street 1:8220 MEMPHIS AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2612
Practice Address - Country:US
Practice Address - Phone:806-687-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist