Provider Demographics
NPI:1689803132
Name:BRAWLEY, CARMEN MONIQUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MONIQUE
Last Name:BRAWLEY
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 1:2906 W GANDY BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2800
Mailing Address - Country:US
Mailing Address - Phone:256-762-9953
Mailing Address - Fax:
Practice Address - Street 1:825 W M.L.K. BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-237-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014900122300000X
NV69571223G0001X
FLDN187311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist