Active NPI
Travis Royce Baskerville, DMD
- Dentist
- Vancouver, WA
National Provider Identifier
1699203109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 60772184
- Practice address
- 12116 SE Mill Plain Blvd
Vancouver, WA 98684 - Phone
- (360) 256-8200
- NPI assigned
- May 28, 2017
- Last updated
- Aug 20, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 60772184 | WA | Primary |
Addresses
Primary practice location
12116 SE Mill Plain Blvd
Vancouver, WA 98684
Mailing address
503 N 41St Ave
Ridgefield, WA 98642-8074
Phone (503) 709-9322
Other practice location 1
16600 SE 15th St Unit B
Vancouver, WA 98683-9502
Phone (360) 282-7435
Other practice location 2
5071 NE 122nd Ave
Portland, OR 97230-1003
Phone (503) 255-5700
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 |
|---|---|---|---|
| 60772184 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morgan L Andersen, DDS, PS | Dentist | Past | Accepting new patients |
| Baseline Dental LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Vancouver, WA
- NPI 1134265655
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534723200000",
"number": "1699203109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 N 41ST AVE",
"city": "RIDGEFIELD",
"state": "WA",
"postal_code": "986428074",
"telephone_number": "503-709-9322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12116 SE MILL PLAIN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98684",
"telephone_number": "360-256-8200"
}
],
"practiceLocations": [
{
"address_1": "16600 SE 15th St Unit B",
"address_purpose": "LOCATION",
"city": "Vancouver",
"state": "WA",
"postal_code": "986839502",
"country_code": "US",
"telephone_number": "360-282-7435",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5071 NE 122nd Ave",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972301003",
"country_code": "US",
"telephone_number": "503-255-5700",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BASKERVILLE",
"first_name": "TRAVIS",
"middle_name": "ROYCE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-28",
"last_updated": "2018-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "60772184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.