NPIMap

Organization Active NPI

1801 Southern Vista Dental Care

Doing business as Southern Vista Dental Care

  • Dentist
  • Mesa, AZ
National Provider Identifier
1023102183
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6591 Issued in AZ
Legal business name
1801 SOUTHERN VISTA DENTAL CARE
Doing business as
Southern Vista Dental Care
Practice address
1801 E Southern Ave
Suite 103
Mesa, AZ 85204-5258
Phone
(480) 892-9000
Fax
(480) 926-0545
NPI assigned
Oct 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Elwynn Chad Caffall Sr., DDSNPI 1639370745
Title
Direct Owner
Phone
(480) 892-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 6283 AZ
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 2561 AZ
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 6591 AZ Primary

Addresses

Primary practice location

1801 E Southern Ave
Suite 103
Mesa, AZ 85204-5258

Mailing address

1801 E Southern Ave
Suite 103
Mesa, AZ 85204-5258
Phone (480) 892-9000

Other names 1

  • Southern Vista Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

1801 E Southern Ave
Ste 103
Mesa, AZ 85204
Phone (480) 892-9000

Practitioners & affiliated clinicians

Practitioners 1

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": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023102183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 E SOUTHERN AVE",
            "address_2": "SUITE 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852045258",
            "telephone_number": "480-892-9000",
            "fax_number": "480-926-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E SOUTHERN AVE",
            "address_2": "SUITE 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852045258",
            "telephone_number": "480-892-9000",
            "fax_number": "480-926-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1801 SOUTHERN VISTA DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CAFFALL",
        "authorized_official_first_name": "ELWYNN",
        "authorized_official_middle_name": "CHAD",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "480-892-9000",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "6283",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "2561",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "6591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Vista Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.