Tiedeman, Thomas Leonard

Tiedeman, Thomas Leonard is an individual health care provider with primary practice located at 2918 Hamilton Blvd Upper D Suite 1, Sioux City IA 51104. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Tiedeman, Thomas Leonard can be contacted via phone (712) 255-1163.

Contact Information

Primary practice address
2918 Hamilton Blvd Upper D Suite 1 Sioux City IA 51104
Phone: (712) 255-1163
Fax: (712) 252-6157
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 05944 Iowa

Profile Details

NPI number 1063553410
LBN Legal business name Tiedeman, Thomas Leonard
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2007
Last updated Jul 8th, 2007 - about 18 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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Identifiers

StateTypeNumberIssuer
All States NPI 1063553410 NPPES
Iowa MEDICAID 0055947

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