Provider Demographics
NPI:1831472414
Name:SCHWARZ, TRAVIS C (DMD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:C
Last Name:SCHWARZ
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 1:8618 MEXICO RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-7507
Mailing Address - Country:US
Mailing Address - Phone:636-205-4045
Mailing Address - Fax:636-205-4050
Practice Address - Street 1:8618 MEXICO RD
Practice Address - Street 2:SUITE 320
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-7507
Practice Address - Country:US
Practice Address - Phone:636-205-4045
Practice Address - Fax:636-205-4050
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011030941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist