| Entity Name: | BRAVO DENTAL P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Sep 2011 (13 years ago) |
| Document Number: | P11000078360 |
| FEI/EIN Number | 453169776 |
| Address: | 909 N MIAMI BEACH BLVD STE 501, N MIAMI BEACH, FL, 33162, US |
| Mail Address: | 20904 Leeward Ct suite 221, Aventura, FL, 33180, US |
| ZIP code: | 33162 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538436431 | 2011-11-19 | 2016-07-14 | 20904 LEEWARD CT, # 221, AVENTURA, FL, 331803873, US | 909 N MIAMI BEACH BLVD, SUITE 501, NORTH MIAMI BEACH, FL, 331623712, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-496-3856 |
| Phone | +1 305-945-9333 |
Authorized person
| Name | MARIA ALEJANDRA YANEZ BRAVO |
| Role | PRESIDENT |
| Phone | 3054963856 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DN19497 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004347700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| waisman Diego A | Agent | 20904 Leeward ct 221, Aventura, FL, 33180 |
| Name | Role | Address |
|---|---|---|
| YANEZ BRAVO MARIA A | Director | 20904 Leeward Ct 221, Aventura, FL, 33180 |
| Name | Role | Address |
|---|---|---|
| WAISMAN DIEGO A | Vice President | 20904 Leeward Ct 221, Aventura, FL, 33180 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-23 | 909 N MIAMI BEACH BLVD STE 501, N MIAMI BEACH, FL 33162 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-03 | 20904 Leeward ct 221, Aventura, FL 33180 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-21 | 909 N MIAMI BEACH BLVD STE 501, N MIAMI BEACH, FL 33162 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-01-21 | waisman, Diego A | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-27 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-02-11 |
| ANNUAL REPORT | 2019-02-19 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-01-23 |
| ANNUAL REPORT | 2016-02-03 |
| ANNUAL REPORT | 2015-02-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
