Provider Demographics
NPI:1962629097
Name:BRAVO, MARIA LIGAYA TAYO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA LIGAYA
Middle Name:TAYO
Last Name: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 1:7413 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2032
Mailing Address - Country:US
Mailing Address - Phone:925-875-9700
Mailing Address - Fax:925-875-9989
Practice Address - Street 1:7413 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2032
Practice Address - Country:US
Practice Address - Phone:925-875-9700
Practice Address - Fax:925-875-9989
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice