Provider Demographics
NPI:1356186324
Name:BRAVO, CAROLINA (DMD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:BRAVO
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 1:136 WIMBLEDON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2423
Mailing Address - Country:US
Mailing Address - Phone:786-227-2396
Mailing Address - Fax:
Practice Address - Street 1:10430 PINES BLVD STE C103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6049
Practice Address - Country:US
Practice Address - Phone:954-251-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL292581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice