Provider Demographics
NPI:1134375744
Name:MAXWELL, TRAVER LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:TRAVER
Middle Name:LOUIS
Last Name:MAXWELL
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 W TELEGRAPH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-1675
Mailing Address - Country:US
Mailing Address - Phone:435-673-4605
Mailing Address - Fax:435-688-9751
Practice Address - Street 1:3300 E 1ST AVE STE 500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5809
Practice Address - Country:US
Practice Address - Phone:720-499-1447
Practice Address - Fax:720-399-1428
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9803122300000X
UT70302421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist