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General NPI Number Information
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NPI Number | 1366670929
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Entity Type | Individual
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Provider Name | TREVOR LEE CAFFALL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 6812 E. BROWN RD. STE 102
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City | MESA
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State | AZ
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Zip | 85207
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Country | US
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Telephone | 480-981-8560
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Fax | 480-324-1394
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Provider Business Mailing Address
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Address Line | 6812 E. BROWN RD. STE 102
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City | MESA
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State | AZ
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Zip | 85207
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Country | US
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Telephone | 480-981-8560
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Fax | 480-324-1394
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7794
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License Number State | AZ
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