Active NPI
Bradley David Revenis, DDS
- Dentist
- Fallon, NV
National Provider Identifier
1609385368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9872
- Practice address
- Branch Health Clinic Fallon
383 Churchill Ave
Fallon, NV 89406 - Phone
- (775) 426-3164
- NPI assigned
- Sep 26, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9872 | AZ | Primary |
Addresses
Primary practice location
Branch Health Clinic Fallon
383 Churchill Ave
Fallon, NV 89406
Mailing address
Nmrtu Fallon
383 Churchill Ave
Fallon, NV 89406
Phone (775) 426-3164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9872 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783641600000",
"number": "1609385368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NMRTU FALLON",
"address_2": "383 CHURCHILL AVE",
"city": "FALLON",
"state": "NV",
"postal_code": "89406",
"telephone_number": "775-426-3164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BRANCH HEALTH CLINIC FALLON",
"address_2": "383 CHURCHILL AVE",
"city": "FALLON",
"state": "NV",
"postal_code": "89406",
"telephone_number": "775-426-3164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVENIS",
"first_name": "BRADLEY",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-09-26",
"last_updated": "2026-07-10",
"certification_date": "2026-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "9872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fallon, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.