Organization
BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID FRAUSTO JR. DDS (PRESIDENT)
(928) 775-9495
Entity
Organization
Contact information
Practice address
7136 PAV WAY, PRESCOTT VALLEY, AZ 86314-2264
(928) 775-9495
Mailing address
7136 PAV WAY, PRESCOTT VALLEY, AZ 86314-2264
(928) 775-9495
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D5639
AZ
Other
Enumeration date
03/04/2008
Last updated
03/04/2008
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