Provider Demographics
NPI:1194951590
Name:CAMPBELL, TRAVIS MCKAY (DDS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MCKAY
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10817 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-3938
Mailing Address - Country:US
Mailing Address - Phone:972-533-2458
Mailing Address - Fax:
Practice Address - Street 1:2111 E UNIVERSITY DR
Practice Address - Street 2:SUITE 20
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7238
Practice Address - Country:US
Practice Address - Phone:972-346-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist