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General NPI Number Information
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NPI Number | 1497016851
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Entity Type | Individual
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Provider Name | ALEXANDRA BRAVOCO D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 100 HIGHLAND AVE STE 103
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City | SALEM
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State | MA
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Zip | 01970-2702
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Country | US
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Telephone | 978-740-5135
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Fax |
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Provider Business Mailing Address
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Address Line | 123 LONDON ST
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City | BOSTON
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State | MA
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Zip | 02128-3035
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Country | US
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Telephone | 617-567-3537
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN1855942
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License Number State | MA
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