Provider Demographics
NPI:1093027344
Name:FIEGLE, TRAVIS JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:JAMES
Last Name:FIEGLE
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 1:102 BUCKWALTER PKWY STE 3J
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4130
Mailing Address - Country:US
Mailing Address - Phone:843-836-3010
Mailing Address - Fax:
Practice Address - Street 1:102 BUCKWALTER PKWY STE 3J
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4130
Practice Address - Country:US
Practice Address - Phone:843-836-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0140701223X0400X
SC81511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics