=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619718749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAVIS BARR DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3333 S WADSWORTH BLVD UNIT D305
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-5142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-985-1615
-----------------------------------------------------
Fax | 303-985-1617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 S WADSWORTH BLVD UNIT D305
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-5142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-985-1615
-----------------------------------------------------
Fax | 303-985-1617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TRAVIS BARR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 303-985-1615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------