Healthcare Provider Details

I. General information

NPI: 1033524871
Provider Name (Legal Business Name): TRAVIS MCMAINE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD STE 175
LEXINGTON KY
40504-3523
US

IV. Provider business mailing address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-8873
  • Fax: 859-323-7193
Mailing address:
  • Phone: 706-721-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9451
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDNF000452
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number104919
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9451
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number92043
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDNF000452
License Number StateGA
# 7
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number9451
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: