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DIANE BRAVO
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1982265708
Individual Registrant: DIANE BRAVO
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
801 S FEDERAL HWY STE 829 DANIA BEACH, FL 33004-4374 US
Tel: 954-925-2977 Fax: --
Tel: 954-925-2977 Fax: --
Contact information for business:
171 E 4TH ST UNIT 8 HIALEAH, FL 33010-7001 US
Tel: 786-447-2571 Fax: --
Tel: 786-447-2571 Fax: --
Registration Information:
NPI: 1982265708
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 122300000X | Dental Providers Dentist | FL | DN24228 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| FLORIDA DENTAL LICENSE | DN24228 | FL | 01 |
