Provider Demographics
NPI:1932281847
Name:MILLER, TRAVIS TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:TODD
Last Name:MILLER
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 1:3314 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-2914
Mailing Address - Country:US
Mailing Address - Phone:409-883-8809
Mailing Address - Fax:409-883-4952
Practice Address - Street 1:3314 CONCORD ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-2914
Practice Address - Country:US
Practice Address - Phone:409-883-8809
Practice Address - Fax:409-883-4952
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist