Provider Demographics
NPI:1992238349
Name:CHIDSEY, CAITLIN MARIE (DMD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
Last Name:CHIDSEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MARIE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:16772 S SKYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3710
Mailing Address - Country:US
Mailing Address - Phone:913-302-4622
Mailing Address - Fax:
Practice Address - Street 1:13541 MADISON AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1669
Practice Address - Country:US
Practice Address - Phone:816-942-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041599122300000X
MO2018002595122300000X
KS61323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist