Healthcare Provider Details

I. General information

NPI: 1912796590
Provider Name (Legal Business Name): BRAVO DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CALLE MUNOZ RIVERA
JUNCOS PR
00777-3469
US

IV. Provider business mailing address

PO BOX 403
JUNCOS PR
00777-0403
US

V. Phone/Fax

Practice location:
  • Phone: 787-734-1575
  • Fax:
Mailing address:
  • Phone: 787-734-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICARDO A BRAVO
Title or Position: VICEPRESIDENT
Credential: DMD
Phone: 787-734-1575