1801 Southern Vista Dental Care

NPI #1023102183 in Mesa, Arizona

Provider Information

NPI Number: 1023102183
Entity Type: Organization
Organization Name: 1801 Southern Vista Dental Care
Primary Specialty: Dentist
Enumeration Date: Oct 3, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1801 E SOUTHERN AVE
Address 2: SUITE 103
City: Mesa
State: Arizona
ZIP Code: 85204-5258
Phone: (480) 892-9000

Authorized Official

Name: ELWYNN CHAD CAFFALL SR., DDS
Title: DIRECT OWNER
Phone: (480) 892-9000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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