Provider Demographics
NPI:1366670929
Name:CAFFALL, TREVOR LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:LEE
Last Name:CAFFALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 E. BROWN RD.
Mailing Address - Street 2:STE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207
Mailing Address - Country:US
Mailing Address - Phone:480-981-8560
Mailing Address - Fax:480-324-1394
Practice Address - Street 1:6812 E. BROWN RD.
Practice Address - Street 2:STE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207
Practice Address - Country:US
Practice Address - Phone:480-981-8560
Practice Address - Fax:480-324-1394
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist