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General NPI Number Information
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NPI Number | 1265011688
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Entity Type | Organization
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Legal Business Name | BRAVAZ DENTAL LLC
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Dates
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Enumeration Date | 04/04/2021
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Last Update Date | 04/04/2021
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Provider Practice Location Address
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Address Line | 4700 SHERIDAN ST STE A1
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3416
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Country | US
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Telephone | 954-966-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 SHERIDAN ST STE A1
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3416
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Country | US
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Telephone | 954-966-1166
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LISSANDRA M VAZQUEZ GRILLO
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Credential |
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Telephone | 954-966-1166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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