Provider Demographics
NPI:1376975144
Name:REDDY, CAITLIN MARIE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:MARIE
Last Name:REDDY
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1110
Mailing Address - Country:US
Mailing Address - Phone:253-968-3336
Mailing Address - Fax:
Practice Address - Street 1:9900 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1110
Practice Address - Country:US
Practice Address - Phone:253-968-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010210241223P0300X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice