NPIMap

Organization Active NPI

John K Tidwell DDS PS

  • Oral and Maxillofacial Surgery (Dentist)
  • Seattle, WA
National Provider Identifier
1245668631
Registry record updated Oct 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DE00006884 Issued in WA
Legal business name
JOHN K TIDWELL DDS PS
Practice address
1801 NW Market St
Suite 108
Seattle, WA 98107-3987
Phone
(206) 783-9672
NPI assigned
Oct 22, 2013
Last updated
Oct 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2013

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

Authorized official

Name
Elizabeth Barnes
Title
Manager
Phone
(206) 783-9672

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DE00006884 WA Primary

Addresses

Primary practice location

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

Mailing address

1801 NW Market St
Suite 108
Seattle, WA 98107-3987
Phone (206) 783-9672

Other names 1

  • BALLARD ORAL AND MAXILLOFACIAL SURGERY Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382400000000",
    "number": "1245668631",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN K TIDWELL DDS PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-22",
        "last_updated": "2013-10-22",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "206-783-9672"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00006884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BALLARD ORAL AND MAXILLOFACIAL SURGERY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.