Provider Demographics
NPI:1205263803
Name:FRAWLEY, TRAVIS MAXWELL (DMD)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:MAXWELL
Last Name:FRAWLEY
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 1:4881 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-359-7100
Mailing Address - Fax:803-957-8774
Practice Address - Street 1:4881 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-359-7100
Practice Address - Fax:803-957-8774
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice