BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC; NPI #1972773141
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Contact Information

BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC
7136 PAV WAY
PRESCOTT VALLEY, AZ86314-2264
 Phone: 928-775-9495
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental

261QD0000X
Indicates primary specialty

NPI Profile & details for BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC

NPI Number 1972773141
LBN Legal business name BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC
Authorized official DAVID FRAUSTO - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 03/04/2008
Last updated 03/04/2008 - About 15 years ago
Identifiers
AZ License # D5639
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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