Provider Demographics
NPI:1114687134
Name:BRAUSA DENTAL SMILES DUNDEE LLC
Entity Type:Organization
Organization Name:BRAUSA DENTAL SMILES DUNDEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FABIO
Authorized Official - Middle Name:
Authorized Official - Last Name:JODAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-547-4983
Mailing Address - Street 1:28029 HWY 27
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4276
Mailing Address - Country:US
Mailing Address - Phone:863-258-1093
Mailing Address - Fax:
Practice Address - Street 1:28029 HWY 27
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4276
Practice Address - Country:US
Practice Address - Phone:863-258-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty