NPIMap

Organization Active NPI

Mountain Bridge Dental

  • General Practice Dentistry
  • Mesa, AZ
National Provider Identifier
1508247438
Registry record updated Jun 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7794 Issued in AZ
Legal business name
MOUNTAIN BRIDGE DENTAL
Practice address
6812 E Brown Rd Ste 102
Mesa, AZ 85207-3757
Phone
(480) 981-8560
NPI assigned
Jun 16, 2015
Last updated
Jun 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2015

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

Authorized official

Name
Dr. Trevor Caffall, DENTISTNPI 1366670929
Title
Owner
Phone
(480) 981-8560

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7794 AZ Primary

Addresses

Primary practice location

6812 E Brown Rd Ste 102
Mesa, AZ 85207-3757

Mailing address

6812 E Brown Rd Ste 102
Mesa, AZ 85207-3757
Phone (480) 981-8560

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1434412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434412800000",
    "number": "1508247438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6812 E BROWN RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852073757",
            "telephone_number": "480-981-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6812 E BROWN RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852073757",
            "telephone_number": "480-981-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN BRIDGE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-16",
        "last_updated": "2015-06-16",
        "status": "A",
        "authorized_official_last_name": "CAFFALL",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-981-8560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DENTIST"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "7794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 16, 2015; 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.