Organization
1801 SOUTHERN VISTA DENTAL CARE
Active
Other names
Southern Vista Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
ELWYNN CHAD CAFFALL SR. DDS (DIRECT OWNER)
(480) 892-9000
Entity
Organization
Contact information
Practice address
1801 E SOUTHERN AVE, SUITE 103, MESA, AZ 85204-5258
(480) 892-9000
(480) 926-0545
Mailing address
1801 E SOUTHERN AVE, SUITE 103, MESA, AZ 85204-5258
(480) 892-9000
(480) 926-0545
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2561
AZ
122300000X
Dentist
6283
AZ
122300000X
Dentist
Primary
6591
AZ
Other
Enumeration date
10/03/2006
Last updated
08/22/2020
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