Organization
BRAVAZ DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISSANDRA M VAZQUEZ GRILLO (MANAGER)
(954) 966-1166
Entity
Organization
Contact information
Practice address
4700 SHERIDAN ST STE A1, HOLLYWOOD, FL 33021-3416
(954) 966-1166
Mailing address
4700 SHERIDAN ST STE A1, HOLLYWOOD, FL 33021-3416
(954) 966-1166
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952831711
PPO DENTAL INSURANCE
—
Enumeration date
04/04/2021
Last updated
04/04/2021
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