MEDICARE: DR. TRAVIS NASH D.D.S.

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	4149	SC
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	631	SC

General Provider Information

NPI Number	:	1396808317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS NASH D.D.S.

Provider Business Mailing Address
First Line	:	1127 QUEENSBOROUGH BLVD
Second Line	:	SUITE 107
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-5431
Country	:	US
Telephone Number	:	843-884-6336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 QUEENSBOROUGH BLVD
Second Line	:	SUITE 107
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-5431
Country	:	US
Telephone Number	:	843-884-6336
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	06/09/2008

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