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BRADSHAW MOUNTAIN FAMILY DENTAL NPI 1861855884


NPI Information

NPI: 1861855884
Provider Name: BRADSHAW MOUNTAIN FAMILY DENTAL

Doing Business As: BRADSHAW FAMILY DENTAL

Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization
Address:
7136 PAV WAY
PRESCOTT VALLEY, AZ
ZIP 86314
Phone: (928) 775-9495
Get Directions

BRADSHAW MOUNTAIN FAMILY DENTAL is a preferred provider organization in Prescott Valley, AZ. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. BRADSHAW MOUNTAIN FAMILY DENTAL NPI is 1861855884. The provider is registered as an organization entity type.
The provider Is Doing Business As Bradshaw Family Dental.

The provider's business location address is:

7136 PAV WAY
PRESCOTT VALLEY, AZ
ZIP 86314-264
Phone: (928) 775-9495
Fax: (928) 775-9497

The provider's authorized official is David Frausto .
The authorized official title is Owner and has the following contact phone number (928) 775-9495.

The enumeration date for this NPI number is 3/29/2016 and was last updated on 3/29/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305R00000XPreferred Provider OrganizationYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1722183MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.