DR. OTTO FREDERICK TIDWELL D.D.S. NPI 1407803398

NPI Information

NPI: 1407803398
Provider Name: DR. OTTO FREDERICK TIDWELL, D.D.S.
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

Address:
19323 LIGHTHOUSE PLAZA BLVD
UNIT 4
REHOBOTH BEACH, DE
ZIP 19971
Phone: (302) 226-1606
Get Directions

DR. Otto Frederick Tidwell, D.D.S. is an oral and maxillofacial surgery dentist in Rehoboth Beach, DE. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Otto Frederick Tidwell, D.D.S. NPI is 1407803398. 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:

19323 LIGHTHOUSE PLAZA BLVD
UNIT 4
REHOBOTH BEACH, DE
ZIP 19971-162
Phone: (302) 226-1606
Fax: (302) 226-1609

The enumeration date for this NPI number is 5/27/2006 and was last updated on 1/14/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223S0112X	Dentist	Oral and Maxillofacial Surgery	22DIO1475500	NEW JERSEY	No
2	1223S0112X	Dentist	Oral and Maxillofacial Surgery	DS022622L	PENNSYLVANIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	121367	OTHER	PENNSYLVANIA	UNITED CONCORDIA PROVIDER
2	0060881000	OTHER	PENNSYLVANIA	BLUE CROSS PROVIDER NUMBE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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