Provider Demographics
NPI:1245979319
Name:TRAVIS, QUINTEN (DMD)
Entity type:Individual
Prefix:
First Name:QUINTEN
Middle Name:
Last Name:TRAVIS
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 1:251 EVAN LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2600
Mailing Address - Country:US
Mailing Address - Phone:270-977-3959
Mailing Address - Fax:
Practice Address - Street 1:3802 PAXTON AVE STE 12A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2399
Practice Address - Country:US
Practice Address - Phone:513-898-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10602122300000X
OH30.026760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist