Tidaback, Dale Roger

Tidaback, Dale Roger is an sole proprietor health care provider with primary practice located at 4881 Sugar Maple Dr , Wright Patterson Afb OH 45433-5529. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Aerospace Medicine. Allopathic & Osteopathic Physicians / Aerospace Medicine is his primary health care specialty. Tidaback, Dale Roger can be contacted via phone (703) 994-8148.

Contact Information

Primary practice address
4881 Sugar Maple Dr Wright Patterson Afb OH 45433-5529
Phone: (703) 994-8148
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 1559 South Dakota
Allopathic & Osteopathic Physicians / Aerospace Medicine 2083A0100X 1559 South Dakota

Profile Details

NPI number 1710963772
LBN Legal business name Tidaback, Dale Roger
Credentials MD, MPH
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 21st, 2005
Last updated Dec 2nd, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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