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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