Individual
DIANE BRAVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11395 SW 40TH ST, MIAMI, FL 33165-4420
(786) 418-6757
(786) 418-6756
Mailing address
171 E 4TH ST UNIT 8, HIALEAH, FL 33010-7001
(786) 447-2571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN24228
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN24228
FLORIDA DENTAL LICENSE
FL
Enumeration date
06/24/2019
Last updated
05/28/2024
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