Travis Shore, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D010774 Issued in AZ

Practice address

1993 Frontage Rd Ste 208
Sierra Vista, AZ 85635-4695

Phone

(520) 458-4646

NPI assigned

Jul 10, 2020

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Canyon Vista Dental

  • General Practice Dentistry
  • Sierra Vista, AZ
  • NPI 1518515212
  NPD
• Gayle Y. Lundtvedt, D.M.D., P.C.

  • Dental Clinic/Center
  • Sierra Vista, AZ
  • NPI 1871644211
  NPD (past)

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

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1891313300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 SENTINEL PEAK RD",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856351496",
            "telephone_number": "509-844-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1993 FRONTAGE RD STE 208",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354695",
            "telephone_number": "520-458-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "TRAVIS",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-10",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "PD0023",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Ann Sheean, OTR
• Heather Renee Sheets, MA INTERN
• Hamza Mehmood Sheikh
• Jacquelyn Shelton-Raftery, MS, MFT, LAC
• Shirley a Auchincloss Otr PC (Cochise Occupational Therapy)
• Elizabeth Amber Shuey, SLPA
• Hortensia Shute
• Sierra Compounding LLC (Sierra Pharmacy & Compounding Lab)
• Sierra Gastroenterology, PLLC.
• Sierra Hearing Center LLC

• General Practice Dentistry in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.