MEDICARE: DR. CODY EARL CAFFALL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D009727	AZ

General Provider Information

NPI Number	:	1164951182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY EARL CAFFALL DDS

Provider Business Mailing Address
First Line	:	1801 E SOUTHERN AVE STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5258
Country	:	US
Telephone Number	:	480-892-9000
Fax Number	:	480-926-0545

Provider Business Practice Location Address
First Line	:	1801 E SOUTHERN AVE STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5258
Country	:	US
Telephone Number	:	480-892-9000
Fax Number	:	480-926-0545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	07/21/2022

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