Provider Demographics
NPI:1962294710
Name:BRAVO DENTAL
Entity type:Organization
Organization Name:BRAVO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:F
Authorized Official - Last Name:NE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:214-704-6778
Mailing Address - Street 1:4001 MCEWEN RD STE 408
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5054
Mailing Address - Country:US
Mailing Address - Phone:214-704-6778
Mailing Address - Fax:
Practice Address - Street 1:3308 DEEN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-6524
Practice Address - Country:US
Practice Address - Phone:214-884-9815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty