Provider Demographics
NPI:1558324459
Name:THOMPSON, JOHN TRAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TRAVIS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:21660 W FIELD PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7265
Mailing Address - Country:US
Mailing Address - Phone:847-381-0106
Mailing Address - Fax:847-381-0265
Practice Address - Street 1:21660 W FIELD PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:DEER PARK
Practice Address - State:IL
Practice Address - Zip Code:60010-7265
Practice Address - Country:US
Practice Address - Phone:847-381-0106
Practice Address - Fax:847-381-0265
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL190246121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery