Provider Demographics
NPI:1073357752
Name:BRAVO, ISABEL ANTOINETTE (DDS)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:ANTOINETTE
Last Name:BRAVO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 WEXFORD RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8047
Mailing Address - Country:US
Mailing Address - Phone:219-477-8384
Mailing Address - Fax:
Practice Address - Street 1:233 E 84TH DR STE 106
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6454
Practice Address - Country:US
Practice Address - Phone:219-736-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014466A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist