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Dr. Randolph Thomas Travis, DMD
General Practice Dentistry in Madisonville, Kentucky
NPI 1407862626

Randolph Thomas Travis is a General Practice Dentistry based in Madisonville, KY and is specialized in General Practice. Randolph Thomas Travis practices in Madisonville, KY and has the professional credentials of DMD. The NPI Number for Randolph Thomas Travis is 1407862626 and holds a License No. KY. 5141 (Kentucky).

The current practice location address for Randolph Thomas Travis is 1400 Pride Avenue, Madisonville, KY and can be reached out via phone at 270-821-7386 and via fax at 270-821-7401. You can also correspond with Randolph Thomas Travis through the mailing address at 1400 PRIDE AVENUE, MADISONVILLE, KY - 42431-9108 (mailing address contact number: 270-821-7386).

Location: 1400 Pride Avenue, Madisonville, KY, 42431-9108
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1407862626
Provider Name
Randolph Thomas Travis
Credential
DMD
Provider Entity Type
Individual
Gender
Male
Address
1400 Pride Avenue, Madisonville, KY, 42431-9108
Phone Number
270-821-7386
Fax Number
270-821-7401
Provider Enumeration Date
07/31/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
600-51414 05 KY
45608965 01 KY EPSDT
200265680 A 05 IN
institution
Provider Business Practice Location Address Details
Address
1400 Pride Avenue
City
Madisonville
State
Kentucky
Zip
42431-9108
Phone Number
270-821-7386
Fax Number
270-821-7401
person
Provider Business Mailing Address Details
Address
1400 Pride Avenue
City
Madisonville
State
Kentucky
Zip
42431-9108
Phone Number
270-821-7386
Fax Number
270-821-7401
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
INDIANA 12010320A (Kentucky)
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
person
Provider's Taxonomy Details 2
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
KY. 5141 (Kentucky)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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