Healthcare Provider Details

I. General information

NPI: 1922328194
Provider Name (Legal Business Name): TRAVIS RAYMOND BUXTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 STATE ST SUITE 2B
BANGOR ME
04401-5439
US

IV. Provider business mailing address

792 STILLWATER AVE
BANGOR ME
04401-3617
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-1166
  • Fax:
Mailing address:
  • Phone: 207-947-1166
  • Fax: 207-947-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4146
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: