MEDICARE: DR. TRAVIS DUANE LUTZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.020826	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9182631	OTHER	OH	DORAL
2	06131	OTHER	OH	PARAMOUNT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295852655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS DUANE LUTZ DDS

Provider Business Mailing Address
First Line	:	PO BOX 316
Second Line	:
City	:	CELINA
State	:	OH
Zip	:	45822-0316
Country	:	US
Telephone Number	:	419-586-1615
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E WAYNE ST
Second Line	:
City	:	CELINA
State	:	OH
Zip	:	45822-1359
Country	:	US
Telephone Number	:	419-586-1615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	11/04/2020

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