Healthcare Provider Details

I. General information

NPI: 1295464980
Provider Name (Legal Business Name): ALEXANDRA ELIZABETH TRAVIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 STATE ST
SCHENECTADY NY
12304-2610
US

IV. Provider business mailing address

38 SHAKER BAY RD
LATHAM NY
12110-1254
US

V. Phone/Fax

Practice location:
  • Phone: 518-370-1441
  • Fax: 518-395-9431
Mailing address:
  • Phone: 518-810-2843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number063745
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: