Risa Maree Record, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

BR9294353 Issued in TX

Practice address

618 Dental Company (As)
Unit #15662 BLDG. S137 Texas Avenue
Camp Carroll, APO AP 96260-5662
KR

Phone

(352) 765-7185

Fax

(352) 765-7188

NPI assigned

Feb 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Risa Maree Poortvliet Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 31, 2015 through Dec 31, 2027

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Gainesville Family Dentistry, PC

  • General Practice Dentistry
  • Gainesville, TX
  • NPI 1881914679
  NPD (past)
• Powell and Record, DDS, PLLC

  • General Practice Dentistry
  • Gainesville, TX
  • NPI 1588684351
  NPD (past)

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1881667053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 COUNTY ROAD 294",
            "city": "GAINESVILLE",
            "state": "TX",
            "postal_code": "762408436",
            "telephone_number": "940-612-2916"
        },
        {
            "country_code": "KR",
            "country_name": "Korea, Republic of",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "618 DENTAL COMPANY (AS)",
            "address_2": "UNIT #15662 BLDG. S137 TEXAS AVENUE",
            "city": "CAMP CARROLL",
            "state": "APO AP",
            "postal_code": "962605662",
            "telephone_number": "352-765-7185",
            "fax_number": "352-765-7188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RECORD",
        "first_name": "RISA",
        "middle_name": "MAREE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-08",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "BR9294353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AGD/TAGD NUMBER",
            "identifier": "196626",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RISA",
            "last_name": "POORTVLIET",
            "middle_name": "MAREE",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.