NPIMap

Organization Active NPI

Bradshaw Mountain Family Dental

Doing business as bradshaw family dental

  • Preferred Provider Organization
  • Prescott Valley, AZ
National Provider Identifier
1861855884
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
BRADSHAW MOUNTAIN FAMILY DENTAL
Doing business as
bradshaw family dental
Practice address
7136 Pav Way
Prescott Valley, AZ 86314-2264
Phone
(928) 775-9495
Fax
(928) 775-9497
NPI assigned
Mar 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Frausto Jr., DDSNPI 1619021425
Title
Owner
Phone
(928) 775-9495

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X Primary

Addresses

Primary practice location

7136 Pav Way
Prescott Valley, AZ 86314-2264

Mailing address

7136 Pav Way
Prescott Valley, AZ 86314-2264
Phone (928) 775-9495

Other identifiers 1

IdentifierTypeStateIssuer
722183MedicaidAZ

Other names 1

  • bradshaw family dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bradshaw Family Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7136 Pav Way
Prescott Valley, AZ 86314
Phone (928) 775-9495

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1861855884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7136 PAV WAY",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142264",
            "telephone_number": "928-775-9495",
            "fax_number": "928-775-9497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7136 PAV WAY",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142264",
            "telephone_number": "928-775-9495",
            "fax_number": "928-775-9497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADSHAW MOUNTAIN FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "FRAUSTO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-775-9495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "722183",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "bradshaw family dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.