Provider Demographics
NPI:1790886281
Name:WPF HOLDINGS LLC
Entity Type:Organization
Organization Name:WPF HOLDINGS LLC
Other - Org Name:SOUTHERN VISTA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELWYNN
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:CAFFALL
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-892-9000
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6591122300000X
AZ2561122300000X
AZ6283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty