Provider Demographics
NPI:1336821982
Name:BRAVO, RICARDO ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ANTONIO
Last Name:BRAVO
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 403
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0403
Mailing Address - Country:US
Mailing Address - Phone:787-734-1575
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3469
Practice Address - Country:US
Practice Address - Phone:787-734-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice