Thomas Vincent Brislin Jr., DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS104296 Issued in CA

Practice address

4765 Carmel Mountain Rd Ste 208
San Diego, CA 92130-6657

Phone

(858) 259-4765

NPI assigned

Sep 21, 2011

Last updated

Mar 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Amir Mojaver DMD PC

  dba Modern Dentistry

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1457565178
  NPD (past)
• K. Ardjmand, D.D.S., Inc.

  dba modern dentistry

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1689708380
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1740563253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LEHIGH AVE",
            "address_2": "NAVY MEDICINE SUPPORT COMMAND",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191251012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4765 CARMEL MOUNTAIN RD STE 208",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921306657",
            "telephone_number": "858-259-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISLIN",
        "first_name": "THOMAS",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-21",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS038822",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DS104296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miriam Briseno
• Rachel Briseno
• Theodore Phillip Briski Jr., PHARM.D.
• Rebecca Fu Brisley
• Teri Brislin, MA OTR/L
• Lauren Brister, RN
• Bristol Hospice - San Diego, LLC
• Aurora Rayn Bristol
• Brit in Home Physical Therapy LTD
• Brit-in-Home Physical Therapy LTD

• Oral and Maxillofacial Surgery (Dentist) in San Diego, CA
• Providers in San Diego, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.