| Bertha D. Bravo Dentist Pc | |
|
362 W Old Country Rd Hicksville NY 11801-4113 | |
| (516) 933-3000 | |
| (516) 933-3001 |
| Full Name | Bertha D. Bravo Dentist Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 362 W Old Country Rd, Hicksville, New York |
| Authorized Official Name and Position | Bertha Dina Bravo (DENTIST) |
| Authorized Official Contact | 5169333000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bertha D. Bravo Dentist Pc 362 W Old Country Rd Hicksville NY 11801-4113 Ph: (516) 933-3000 | Bertha D. Bravo Dentist Pc 362 W Old Country Rd Hicksville NY 11801-4113 Ph: (516) 933-3000 |
| NPI Number | 1184896912 |
|---|---|
| Provider Enumeration Date | 04/01/2008 |
| Last Update Date | 02/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184896912 | NPI | - | NPPES |
| 01353584 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 044278 (New York) | Primary |
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