Provider Demographics
NPI:1497016851
Name:BRAVOCO, ALEXANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:BRAVOCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 LONDON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-3035
Mailing Address - Country:US
Mailing Address - Phone:617-567-3537
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAND AVE STE 103
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2702
Practice Address - Country:US
Practice Address - Phone:978-740-5135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist