=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003021262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAVIS J. CALHOUN, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 MEDICAL PARK DR SUITE B
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-2493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-277-2722
-----------------------------------------------------
Fax | 828-277-2724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 MEDICAL PARK DR SUITE B
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-2493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-277-2722
-----------------------------------------------------
Fax | 828-277-2724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | STEPHANIE R HANNAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-277-2722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6423
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------