Bravo Dental Corporation
Clinic/Center, Dental in Anaheim, CA. Organization (NPI-2).
NPI number1548094436
StatusActive
Last updated in NPPESSep 2, 2024
Details
- NPI
- 1548094436
- Entity type
- Organization (NPI-2)
- Legal business name
- Bravo Dental Corporation
- Organization subpart
- No
- Enumeration date
- Sep 2, 2024
- Certification date
- Sep 1, 2024
- Last updated
- Sep 2, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
215 N State College Blvd Ste EAnaheim, CA 92806-2934
Phone 714-635-0892
Mailing address
215 N State College Blvd Ste EAnaheim, CA 92806-2934
Phone 714-635-0892
Authorized official
Luz S Bravo
President/Dentist
7146350892
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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