Provider Demographics
NPI:1194865584
Name:BRAVO, MARIA DEL CARMEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DEL CARMEN
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 1:10322 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1746
Mailing Address - Country:US
Mailing Address - Phone:305-554-6054
Mailing Address - Fax:305-554-6054
Practice Address - Street 1:10322 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1746
Practice Address - Country:US
Practice Address - Phone:305-554-6054
Practice Address - Fax:305-554-6054
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00130381223G0001X
FL126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered126800000XDental ProvidersDental Assistant