# SEASONS SAGE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bradshaw Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972085660
- **Authorized official:** DR. DAVID FRAUSTO DDS (OWNER)
- **Authorized official phone:** (928) 237-1305

## Contact information

- **Practice address:** 1260 S STATE ROUTE 89 STE G, CHINO VALLEY, AZ 86323-6624
- **Practice address phone:** (928) 237-1305
- **Practice address fax:** (928) 237-3038
- **Mailing address:** 1260 S STATE ROUTE 89 STE G, CHINO VALLEY, AZ 86323-6624
- **Mailing address phone:** (928) 237-1305
- **Mailing address fax:** (928) 237-3038

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | D5639 | AZ | Yes |

## Other

- **Enumeration date:** 08/30/2018
- **Last updated:** 08/30/2018