Provider Demographics
NPI:1396808317
Name:NASH, TRAVIS (DDS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:NASH
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 1:1127 QUEENSBOROUGH BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5431
Mailing Address - Country:US
Mailing Address - Phone:843-884-6336
Mailing Address - Fax:
Practice Address - Street 1:1127 QUEENSBOROUGH BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5431
Practice Address - Country:US
Practice Address - Phone:843-884-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4149122300000X
SC6311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist