Provider Demographics
NPI:1285807503
Name:BRAL, MITRA H (DDS)
Entity type:Individual
Prefix:DR
First Name:MITRA
Middle Name:H
Last Name:BRAL
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 1:10433 WILSHIRE BLVD
Mailing Address - Street 2:APT #1103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4637
Mailing Address - Country:US
Mailing Address - Phone:310-278-5159
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:STE. 716
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:310-278-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist