Provider Demographics
NPI:1891206421
Name:THOMAS, TRAVIS LYNELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:LYNELL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 RIVERPATH DR APT 38
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3898
Mailing Address - Country:US
Mailing Address - Phone:857-308-6346
Mailing Address - Fax:
Practice Address - Street 1:15 CONCORD RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2328
Practice Address - Country:US
Practice Address - Phone:978-467-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18577661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice