Healthcare Provider Details

I. General information

NPI: 1255302105
Provider Name (Legal Business Name): DR. TRAVIS THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MILITARY TRAIL SUITE 110
JUPITER FL
33458
US

IV. Provider business mailing address

1025 MILITARY TRAIL SUITE 110
JUPITER FL
33458
US

V. Phone/Fax

Practice location:
  • Phone: 561-743-8311
  • Fax: 561-744-6201
Mailing address:
  • Phone: 561-743-8311
  • Fax: 561-744-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDN14670
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN14670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: