Healthcare Provider Details

I. General information

NPI: 1346533080
Provider Name (Legal Business Name): JOSEPH WILLIAM TRAVERS JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CLARK ST
NORFOLK MA
02056
US

IV. Provider business mailing address

31 WHEELER ST UNIT 203
CAMBRIDGE MA
02138-1143
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-0800
  • Fax:
Mailing address:
  • Phone: 617-714-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN17870
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: