Provider Demographics
NPI:1497259790
Name:CLINICA DENTAL BRAVO II LLC
Entity Type:Organization
Organization Name:CLINICA DENTAL BRAVO II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIRANZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-756-8427
Mailing Address - Street 1:PO BOX 20651
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-0651
Mailing Address - Country:US
Mailing Address - Phone:787-756-8427
Mailing Address - Fax:787-756-8427
Practice Address - Street 1:1057 CALLE WILLIAM JONES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3832
Practice Address - Country:US
Practice Address - Phone:787-756-8427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 261QD0000X
PR2054261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty