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General NPI Number Information
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NPI Number | 1033524871
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Entity Type | Individual
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Provider Name | TRAVIS MCMAINE DMD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 2195 HARRODSBURG RD STE 175
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City | LEXINGTON
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State | KY
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Zip | 40504-3523
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Country | US
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Telephone | 859-323-8873
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Fax | 859-323-7193
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Provider Business Mailing Address
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Address Line | 1430 JOHN WESLEY GILBERT DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30912-0001
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Country | US
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Telephone | 706-721-2371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9451
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DNF000452
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 104919
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9451
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 92043
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DNF000452
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 9451
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License Number State | KY
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