TRAVIS C. BRISENO (NPI# 1730679168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730679168 |
| Entity Type | Individual |
| Full Name | TRAVIS C. BRISENO |
| Credential | LD |
| Practice Address |
773 Golf View Dr Medford OR 97504 |
| Mailing Address |
6950 Ne Campus Way Hillsboro OR 97124-5611 |
| Practice Telephone | 8554336825 |
| Practice Fax Number | 5039522267 |
| Mailing Telephone | 8554336825 |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-05-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122400000X | Denturist | DT-TMP-10190928 | OR | Dental Providers |
| Street Address |
773 GOLF VIEW DR |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982760153 | Charles Allen Wagner | Dentist | 773 Golf View Dr, Medford, OR 97504-9643 | 2006-12-29 |
| 1407323165 | Rakesh Gadde | Dentist | 773 Golf View Dr, Medford, OR 97504-9643 | 2018-10-30 |
| 1992114953 | Mikyl Quinn Rasmussen | Dentist | 773 Golf View Dr, Medford, OR 97504-9643 | 2014-08-04 |
| 1508081266 | Richard J. Miller | Dentist | 773 Golf View Dr, Medford, OR 97504-9643 | 2007-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 122400000X |
| Grouping | Dental Providers |
| Classification | Denturist |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518070218 | Western Denture Center Inc. | Denturist | 1055 Court St, Medford, OR 97501-5727 | 2006-08-16 |
| 1760420467 | Adc Dental Clinic, Inc | Denturist | 720 Bennett Ave, Medford, OR 97504-6722 | 2006-06-03 |
| 1477017374 | Joshua Edward Eplett | Denturist | 720 Bennett Ave, Medford, OR 97504-6722 | 2019-01-24 |
| 1477083145 | Erin M Watkins | Denturist | 1113 Progress Dr, Medford, OR 97504 | 2017-06-15 |
| 1225243363 | Edward Eplett | Denturist | 720 Bennett Ave, Medford, OR 97504-6722 | 2007-05-11 |
| 1558576603 | Teresa Eplett | Denturist | 720 Bennett Ave, Medford, OR 97504-6722 | 2007-05-11 |
| 1518074673 | David Russell Dahl | Denturist | 1055 Court St, Medford, OR 97501-5727 | 2006-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316576341 | Madeline M Cain | Denturist | 232 Ne Lincoln St Ste B, Hillsboro, OR 97124-3048 | 2020-04-02 |
| 1013549575 | Christopher Scott Mayo Jr. | Denturist | 937 Chetco Ave Ste. B, Brookings, OR 97415 | 2020-02-12 |
| 1104465525 | Andrew Kyle Burzynski | Denturist | 853 Ne 4th St., Bend, OR 97701 | 2020-01-02 |
| 1063074250 | Rajeev Rugi Siddappa | Denturist | 740 Avenue H, Seaside, OR 97138-6619 | 2019-07-08 |
| 1548760630 | Stephen Depirro II | Denturist | 740 Avenue H Ste 2, Seaside, OR 97138-6603 | 2018-02-15 |
| 1770083172 | Valley Denture Care LLC | Denturist | 535 N 5th St, Jacksonville, OR 97530-9704 | 2018-02-13 |
| 1407364177 | Joseph Rider | Denturist | 1523 Nw Canal Blvd Ste 101, Redmond, OR 97756-1340 | 2018-01-16 |
| 1821503293 | Calvin Daniel Smith | Denturist | 65 Irving Rd, Eugene, OR 97404 | 2017-12-07 |
| 1841642287 | Veronika Buliga | Denturist | 6842 Se 66th Ave, Portland, OR 97206-7449 | 2016-07-11 |
| 1528435237 | Lidiya Bogdan | Denturist | 4637 Se 128th Ave, Portland, OR 97236-3713 | 2015-08-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.