Provider Demographics
NPI:1184754988
Name:BARTSCHI, TRAVIS B (DDS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:B
Last Name:BARTSCHI
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 1:442 BRYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4456
Mailing Address - Country:US
Mailing Address - Phone:208-746-2414
Mailing Address - Fax:208-746-2545
Practice Address - Street 1:442 BRYDEN AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4456
Practice Address - Country:US
Practice Address - Phone:208-746-2414
Practice Address - Fax:208-746-2545
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD37011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806672300Medicaid