Provider Demographics
NPI:1891074183
Name:YANEZ BRAVO, MARIA ALEJANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:YANEZ BRAVO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20904 LEEWARD CT
Mailing Address - Street 2:# 221
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3873
Mailing Address - Country:US
Mailing Address - Phone:305-496-3856
Mailing Address - Fax:
Practice Address - Street 1:995 N MIAMI BEACH BLVD
Practice Address - Street 2:SUITE # 137
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3721
Practice Address - Country:US
Practice Address - Phone:305-945-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN194971223G0001X
VA04014132571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004488700Medicaid