Provider Demographics
NPI:1407126410
Name:TYSINGER, CAITLIN MONHEIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:MONHEIM
Last Name:TYSINGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CAITLIN
Other - Middle Name:JULIA
Other - Last Name:MONHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2005 KNIGHT LN, BLDG H ATTN: MEDICAL STAFF SERVICES
Mailing Address - Street 2:NAVY MEDICINE SUPPORT COMMAND
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LN, BLDG H ATTN: MEDICAL STAFF SERVICES
Practice Address - Street 2:NAVY MEDICINE SUPPORT COMMAND
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212
Practice Address - Country:US
Practice Address - Phone:760-725-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist