Provider Demographics
NPI:1376943233
Name:BRAO, ROSALIE (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:BRAO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14361 METROPOLIS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4453
Mailing Address - Country:US
Mailing Address - Phone:239-571-6161
Mailing Address - Fax:
Practice Address - Street 1:14361 METROPOLIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4453
Practice Address - Country:US
Practice Address - Phone:239-561-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics