Provider Demographics
NPI:1427024876
Name:BRAVO, LUIS J (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:J
Last Name:BRAVO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10392 RAVENSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8822
Mailing Address - Country:US
Mailing Address - Phone:303-934-2389
Mailing Address - Fax:
Practice Address - Street 1:6650 S VINE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-2770
Practice Address - Country:US
Practice Address - Phone:303-805-9256
Practice Address - Fax:303-730-3505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice