Russell, Travis Andre

Russell, Travis Andre is an individual health care provider with primary practice located at 737 S Main St , Society Hill SC 29593-8972. He recently has only one registered license in Dental Providers / Dental Public Health, which is considered as his primary health care specialty. Russell, Travis Andre can be contacted via phone (843) 857-0111.

Contact Information

Primary practice address
737 S Main St Society Hill SC 29593-8972
Phone: (843) 857-0111
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Public Health 1223D0001X 9255 South Carolina

Profile Details

NPI number 1861976839
LBN Legal business name Russell, Travis Andre
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 17th, 2018
Last updated Jun 11th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861976839 NPPES
South Carolina MEDICAID ZX9255

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