MEDICARE: RAQUELINE BRUNO DE SOUSA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	26224	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881265395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUELINE BRUNO DE SOUSA DDS

Provider Business Mailing Address
First Line	:	6211 SAWYER LOOP RD # APAT206
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34238-3069
Country	:	US
Telephone Number	:	585-485-2703
Fax Number	:

Provider Business Practice Location Address
First Line	:	3466 CLARK RD STE 410
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-8406
Country	:	US
Telephone Number	:	941-927-1705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	07/06/2021

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