Healthcare Provider Details

I. General information

NPI: 1487643367
Provider Name (Legal Business Name): TRAVIS LANE CHAPMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 PORTWAY AVENUE 202
HOOD RIVER OR
97031
US

IV. Provider business mailing address

501 PORTWAY AVE STE 202
HOOD RIVER OR
97031-1288
US

V. Phone/Fax

Practice location:
  • Phone: 541-436-2740
  • Fax:
Mailing address:
  • Phone: 541-436-2740
  • Fax: 888-224-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDT-2174
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD9852
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: