Individual provider · Type 1 NPI
Austin Tidwell, DMD
Pediatric Dentistry · Pleasant Grove, UT
NPI number
1265059091
Active
Practice location
1082N N Northcounty Blvd
Pleasant Grove, UT 84062-3400
Mailing address
3040 N Cullen Ct
Pleasant Grove, UT 84062-9443
Other practice locations
- 1001 Shadow Ln # Ms 7423, Las Vegas, NV 89106-4124 · (702) 774-2416
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | 7421 (NV) |
| General Practice Dentistry | 1223G0001X | LL-538-20 (NV) |
| Pediatric Dentistry Primary | 1223P0221X | 12772511-9922 (UT) |
Pediatric Dentistry: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
About NPI 1265059091
Austin Tidwell, DMD's National Provider Identifier is 1265059091, issued on Jun 27, 2020. The primary taxonomy on file is Pediatric Dentistry (1223P0221X), and the practice location is in Pleasant Grove, UT. The record was last updated on Jun 28, 2022.