Individual
TRAVIS C. BRISENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
773 GOLF VIEW DR, MEDFORD, OR 97504
(855) 433-6825
(503) 952-2267
Mailing address
6950 NE CAMPUS WAY, HILLSBORO, OR 97124-5611
(855) 433-6825
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-TMP-10190928
OR
Other
Enumeration date
05/10/2018
Last updated
05/15/2018
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