Active NPI
Stephen Michael Travis, D.D.S
- General Practice Dentistry
- Boulder, CO
National Provider Identifier
1417097213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4850
- Practice address
- 350 Broadway St Ste 10
Boulder, CO 80305-3300 - Phone
- (303) 494-8200
- Fax
- (303) 494-2281
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4850 | CO | Primary |
Addresses
Primary practice location
350 Broadway St Ste 10
Boulder, CO 80305-3300
Mailing address
2491 Linden Dr
Boulder, CO 80304-0427
Phone (303) 444-5998
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84-1094885 | Other | CO | IRS INDIVID. TAXPAYER ID# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4850 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414022400000",
"number": "1417097213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2491 LINDEN DR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803040427",
"telephone_number": "303-444-5998",
"fax_number": "303-541-0101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 BROADWAY ST STE 10",
"city": "BOULDER",
"state": "CO",
"postal_code": "803053300",
"telephone_number": "303-494-8200",
"fax_number": "303-494-2281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAVIS",
"first_name": "STEPHEN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2014-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "4850",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IRS INDIVID. TAXPAYER ID#",
"identifier": "84-1094885",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.