John K. Tidwell, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE00006884 Issued in WA

Practice address

1801 NW Market St
Suite 108
Seattle, WA 98107-3987

Phone

(206) 783-9672

Fax

(206) 784-4812

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Sep 1, 2014 through Sep 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kutcipal & Mahil DDS PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Seattle, WA
  • NPI 1053875096
  NPD
• John K Tidwell DDS PS

  • Oral and Maxillofacial Surgery (Dentist)
  • Seattle, WA
  • NPI 1245668631
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382400000000",
    "number": "1003906835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 NW MARKET ST",
            "address_2": "SUITE 108",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981073987",
            "telephone_number": "206-783-9672",
            "fax_number": "206-784-4812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 NW MARKET ST",
            "address_2": "SUITE 108",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981073987",
            "telephone_number": "206-783-9672",
            "fax_number": "206-784-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JOHN",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2013-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00006884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather S Tick, MD
• Ronald Jay Tickman, MD
• Tidelands Midwifery LLC
• Anika Tideman, D.P.T.
• Stephanie C Tidholm, SUDPT
• Carol B Tiebout, LMP
• Angela Tiede, ARNP, RN
• Joel S Tieder
• Mick L. Tiegs, D.C.
• Michael C. Tielborg

• Oral and Maxillofacial Surgery (Dentist) in Seattle, WA
• Providers in Seattle, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.