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Organization
BRADSHAW MOUNTAIN FAMILY DENTAL
Active
Organization
BRADSHAW MOUNTAIN FAMILY DENTAL
Active
Other names
bradshaw family dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID FRAUSTO JR. DDS (OWNER)
(928) 775-9495
Entity
Organization
Contact information
Practice address
7136 PAV WAY, PRESCOTT VALLEY, AZ 86314-2264
(928) 775-9495
(928) 775-9497
Mailing address
7136 PAV WAY, PRESCOTT VALLEY, AZ 86314-2264
(928) 775-9495
(928) 775-9497
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
722183
—
AZ
Enumeration date
03/29/2016
Last updated
03/29/2016
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