| Southern Vista Dental Care | |
|
1801 E Southern Ave Suite 103 Mesa AZ 85204-5258 | |
| (480) 892-9000 | |
| (480) 926-0545 |
| Full Name | Southern Vista Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 1801 E Southern Ave, Mesa, Arizona |
| Authorized Official Name and Position | Elwynn Chad Caffall (DIRECT OWNER) |
| Authorized Official Contact | 4808929000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Vista Dental Care 1801 E Southern Ave Suite 103 Mesa AZ 85204-5258 Ph: (480) 892-9000 | Southern Vista Dental Care 1801 E Southern Ave Suite 103 Mesa AZ 85204-5258 Ph: (480) 892-9000 |
| NPI Number | 1023102183 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023102183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6283 (Arizona) | Secondary |
| 122300000X | Dentist | 2561 (Arizona) | Secondary |
| 122300000X | Dentist | 6591 (Arizona) | Primary |
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