Provider Demographics
NPI:1972169001
Name:DESMET, CAITLIN COURTNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:COURTNEY
Last Name:DESMET
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 1:2435 WEBSTER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2050
Mailing Address - Country:US
Mailing Address - Phone:510-846-1660
Mailing Address - Fax:
Practice Address - Street 1:2435 WEBSTER ST STE 100
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2050
Practice Address - Country:US
Practice Address - Phone:510-846-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty