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 6 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 |
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