Provider Demographics
NPI:1326533472
Name:JAEGER, TRAVIS WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:WILLIAM
Last Name:JAEGER
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 1:122 SPEER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1033
Mailing Address - Country:US
Mailing Address - Phone:410-778-1104
Mailing Address - Fax:410-778-1269
Practice Address - Street 1:122 SPEER RD STE 1
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1033
Practice Address - Country:US
Practice Address - Phone:410-778-1104
Practice Address - Fax:410-778-1269
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD167501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice