Basic Information
| Provider Information | |||||||||
| NPI: | 1073670550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 344 HEARD STREET, BLDG 556 | ||||||||
| Address2: | |||||||||
| City: | SCHOFIELD BARRACKS | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331106 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BLDG 38801 ACADEMIC DR STE B,C | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067875738 | ||||||||
| FaxNumber: | 7067871970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DS036032 | PA | N | Dental Providers | Dentist | General Practice | 1223S0112X | DN015542 | GA | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | DS036032 | PA | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 9048 | SC | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.