Provider Demographics
NPI:1992968390
Name:BERESFORD, CAITLIN ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:ANNE
Last Name:BERESFORD
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 1:427 E KANESVILLE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4403
Mailing Address - Country:US
Mailing Address - Phone:712-322-5318
Mailing Address - Fax:
Practice Address - Street 1:427 E KANESVILLE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4403
Practice Address - Country:US
Practice Address - Phone:712-322-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice