MEDICARE: DR. TRAVIS LYNELL THOMAS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN1857766	MA
2	1223G0001X	General Practice Dentistry	14153	NC

General Provider Information

NPI Number	:	1891206421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS LYNELL THOMAS DMD

Provider Business Mailing Address
First Line	:	8305 UNIVERSITY EXEC PARK DR STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3357
Country	:	US
Telephone Number	:	980-485-4729
Fax Number	:

Provider Business Practice Location Address
First Line	:	8305 UNIVERSITY EXEC PARK DR STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3357
Country	:	US
Telephone Number	:	980-485-4729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	11/21/2025

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