BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC NPI 1972773141

NPI Information

NPI: 1972773141
Provider Name: BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 03D2244020

Address:
7136 PAV WAY
PRESCOTT VALLEY, AZ
ZIP 86314
Phone: (928) 775-9495
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BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC is a dental clinic center in Prescott Valley, AZ. BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC NPI is 1972773141. The provider is registered as an organization entity type.

The provider's business location address is:

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

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

The CLIA number assigned to this NPI record is 03D2244020 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/4/2008 and was last updated on 3/4/2008.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	D5639	ARIZONA	Yes

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: 11/14/2023

NPI Synchronization or Removal

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