Provider Demographics
NPI:1942681762
Name:SMITH, TRAVIS (DMD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:SMITH
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 1:595 CASTRO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2511
Mailing Address - Country:US
Mailing Address - Phone:415-738-3900
Mailing Address - Fax:415-738-3935
Practice Address - Street 1:595 CASTRO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2511
Practice Address - Country:US
Practice Address - Phone:415-738-3900
Practice Address - Fax:415-738-3935
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice