Tidwell, Bill Shayne
Tidwell, Bill Shayne is an sole proprietor health care provider with primary practice located at Corner Of Route N12 And N7 , Fort Defiance AZ 86504-0589. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Tidwell, Bill Shayne can be contacted via phone (928) 729-8000.Contact Information
Primary practice address
Corner Of Route N12 And N7
Fort Defiance AZ 86504-0589
Phone: (928) 729-8000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 117592 | Alaska |
| Dental Providers / General Practice | 1223G0001X | 7367 | Colorado |
| Dental Providers / General Practice | 1223G0001X | 14581 | Texas |
| Dental Providers / General Practice | 1223G0001X | 6993 | Kansas |
Profile Details
| NPI number | 1053391797 |
|---|---|
| LBN Legal business name | Tidwell, Bill Shayne |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 19th, 2006 |
| Last updated | Oct 18th, 2019 - about 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053391797 | NPPES |
| Kansas | MEDICAID | 100454590A | |
| Kansas | Other | 48-1181104 |
Popular Providers
-
Ray, Kendall L.
2240 E. Winrow Us Army Dental Activity, Fort Huachuca AZ 85613-7040 -
Rice, Donald G
2240 Winrow Rd , Fort Huachuca AZ 85613-5080 -
Bersano, Raymond Bernard
Hqs, U.S. Army Dental Activity 51005 Winans Riley Barracks East Wing, Fort Huachuca AZ 85613-7040 -
Campana, Louis Francis
2240 E. Winrow Ave Us Army Dental Activity, Fort Huachuca AZ 85613-7040 -
Hultgren, Daniel Stratton
Corner Of Route N12& N7 , Fort Defiance AZ 86504 -
Shaughnessy, Kathleen A
Hqs, U.S. Army Dental Activity 51005 Winans Riley Barracks East Wing, Fort Huachuca AZ 85613-7040 -
Do, Quynh Ngan Ngoc
2240 E. Winrow Ave Us Army Dental Command, Fort Huachuca AZ 85613-5080 -
Curleyhair, Shane
Corner Of Route N12 And N7 , Fort Defiance AZ 86504