Active NPI
Travis C. Briseno, LD
- Denturist
- Medford, OR
National Provider Identifier
1730679168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- DT-TMP-10190928
- Practice address
- 773 Golf View Dr
Medford, OR 97504 - Phone
- (855) 433-6825
- Fax
- (503) 952-2267
- NPI assigned
- May 10, 2018
- Last updated
- May 15, 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 |
|---|---|---|---|---|
| Denturist | 122400000X | DT-TMP-10190928 | OR | Primary |
Addresses
Primary practice location
773 Golf View Dr
Medford, OR 97504
Mailing address
6950 NE Campus Way
Hillsboro, OR 97124-5611
Phone (855) 433-6825
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 |
|---|---|---|---|
| DT-TMP-10190928 | OR | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526342400000",
"number": "1730679168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6950 NE CAMPUS WAY",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971245611",
"telephone_number": "855-433-6825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "773 GOLF VIEW DR",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "855-433-6825",
"fax_number": "503-952-2267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISENO",
"first_name": "TRAVIS",
"middle_name": "C.",
"credential": "LD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-10",
"last_updated": "2018-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "OR",
"license": "DT-TMP-10190928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.