DR. Brock Fred Tidstrom, DDS is a general practice dentist in Fairbanks, AK. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Brock Fred Tidstrom, DDS NPI is 1184065435. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
3112 AIRPORT WAY
SUITE 1
FAIRBANKS, AK
ZIP 99709-754
Phone: (907) 452-1250
The NPI 1184065435 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).
The enumeration date for this NPI number is 7/16/2013 and was last updated on 7/16/2013.