Provider Demographics
NPI:1700452653
Name:EIDSON, CAYTLIN DAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAYTLIN
Middle Name:DAWN
Last Name:EIDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10357 S NATHAN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-1839
Mailing Address - Country:US
Mailing Address - Phone:918-606-9189
Mailing Address - Fax:
Practice Address - Street 1:710 W 71ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1825
Practice Address - Country:US
Practice Address - Phone:918-262-8925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK957668867OtherUNITED HEALTHCARE