Provider Demographics
NPI:1346999513
Name:BRAVO WEBB PLLC
Entity Type:Organization
Organization Name:BRAVO WEBB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-870-5254
Mailing Address - Street 1:4803 HIXSON PIKE STE 101
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4486
Mailing Address - Country:US
Mailing Address - Phone:423-870-5254
Mailing Address - Fax:
Practice Address - Street 1:3687 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5819
Practice Address - Country:US
Practice Address - Phone:423-870-5254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty