Provider Demographics
NPI:1639370745
Name:CAFFALL, ELWYNN CHAD (DDS)
Entity Type:Individual
Prefix:
First Name:ELWYNN
Middle Name:CHAD
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 1:1801 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5258
Mailing Address - Country:US
Mailing Address - Phone:480-892-0060
Mailing Address - Fax:480-892-8806
Practice Address - Street 1:1801 E SOUTHERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5258
Practice Address - Country:US
Practice Address - Phone:480-892-0060
Practice Address - Fax:480-892-8806
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZD6591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist