Active NPI
Thomas Leonard Tiedeman, DDS
- General Practice Dentistry
- Sioux City, IA
National Provider Identifier
1063553410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 05944
- Practice address
- 2918 Hamilton Blvd
Upper D Suite 1
Sioux City, IA 51104 - Phone
- (712) 255-1163
- Fax
- (712) 252-6157
- NPI assigned
- Feb 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 05944 | IA | Primary |
Addresses
Primary practice location
2918 Hamilton Blvd
Upper D Suite 1
Sioux City, IA 51104
Mailing address
2918 Hamilton Blvd
Upper D Suite 1
Sioux City, IA 51104
Phone (712) 255-1163
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0055947 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05944 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063553410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2918 HAMILTON BLVD",
"address_2": "UPPER D SUITE 1",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "51104",
"telephone_number": "712-255-1163",
"fax_number": "712-252-6157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2918 HAMILTON BLVD",
"address_2": "UPPER D SUITE 1",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "51104",
"telephone_number": "712-255-1163",
"fax_number": "712-252-6157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIEDEMAN",
"first_name": "THOMAS",
"middle_name": "LEONARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "05944",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0055947",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sioux City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.