Individual
DR. STEPHEN MICHAEL TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
350 BROADWAY ST STE 10, BOULDER, CO 80305-3300
(303) 494-8200
(303) 494-2281
Mailing address
2491 LINDEN DR, BOULDER, CO 80304-0427
(303) 444-5998
(303) 541-0101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4850
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84-1094885
IRS INDIVID. TAXPAYER ID#
CO
Enumeration date
02/08/2007
Last updated
10/23/2014
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