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General NPI Number Information
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NPI Number | 1245022086
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Entity Type | Organization
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Legal Business Name | BRAVO DENTAL
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 3200 W EULESS BLVD
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City | EULESS
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State | TX
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Zip | 76040-6253
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Country | US
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Telephone | 214-884-9814
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 MCEWEN RD STE 408
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City | DALLAS
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State | TX
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Zip | 75244-5054
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Country | US
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Telephone | 214-704-6778
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RITA F. NE
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Credential | D.D.S.,M.S
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Telephone | 214-704-6778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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