Provider Demographics
NPI:1912796590
Name:BRAVO DENTAL LLC
Entity type:Organization
Organization Name:BRAVO DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-734-1575
Mailing Address - Street 1:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0403
Mailing Address - Country:US
Mailing Address - Phone:787-734-1575
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3469
Practice Address - Country:US
Practice Address - Phone:787-734-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental