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General NPI Number Information
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NPI Number | 1972295905
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Entity Type | Organization
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Legal Business Name | CASA ALTA VISTA DENTAL, PA
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 3045 N BUCKNER BLVD STE 100
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City | DALLAS
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State | TX
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Zip | 75228-5292
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Country | US
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Telephone | 214-420-7000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 543471
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City | DALLAS
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State | TX
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Zip | 75354-3471
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROERT TAFEL
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Credential | DDS
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Telephone | 214-420-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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