Provider Demographics
NPI:1891880340
Name:BRAVO GARCIA, CESAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:
Last Name:BRAVO GARCIA
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: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:787-764-8696
Mailing Address - Fax:787-756-8427
Practice Address - Street 1:1057 WILLIAM JONES ST.
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928-1057
Practice Address - Country:US
Practice Address - Phone:787-764-8696
Practice Address - Fax:787-756-8427
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD19291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice