Healthcare Provider Details

I. General information

NPI: 1972967453
Provider Name (Legal Business Name): TRAVIS ALEXANDER WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23680 US HIGHWAY 19 N
CLEARWATER FL
33765-1571
US

IV. Provider business mailing address

2910 W BARCELONA ST UNIT 703
TAMPA FL
33629-7458
US

V. Phone/Fax

Practice location:
  • Phone: 727-470-4069
  • Fax:
Mailing address:
  • Phone: 727-470-4069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN27140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: