Provider Demographics
NPI:1982180923
Name:NEUENHAUS, TRAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:NEUENHAUS
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 1:2 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1206
Mailing Address - Country:US
Mailing Address - Phone:978-578-2220
Mailing Address - Fax:
Practice Address - Street 1:302 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4386
Practice Address - Country:US
Practice Address - Phone:508-636-6566
Practice Address - Fax:508-636-6587
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty