Organization
COMPLETE DENTAL PC
Active
Other names
Bertha D. Bravo Dentist PC
Organization subpart
No
Provider details
NPI number
Authorized official
BERTHA DINA BRAVO (DENTIST)
(516) 933-3000
Entity
Organization
Contact information
Practice address
362 W OLD COUNTRY RD, HICKSVILLE, NY 11801-4113
(516) 933-3000
(516) 933-3001
Mailing address
362 W OLD COUNTRY RD, HICKSVILLE, NY 11801-4113
(516) 933-3000
(516) 485-8386
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
044278
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01353584
—
NY
Enumeration date
04/01/2008
Last updated
02/03/2021
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