Susan Bon Tiede, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2151 Issued in MT

Practice address

3020 S Reserve St Ste D
Suite B
Missoula, MT 59801-7652

Phone

(406) 541-7334

Fax

(406) 541-7338

NPI assigned

Jun 1, 2006

Last updated

Oct 5, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Missoula Pediatric Dentistry PC

  • Pediatric Dentistry
  • Missoula, MT
  • NPI 1942483524
  NPD
• Missoula Pediatric Dentistry, PLLC

  • Pediatric Dentistry
  • Missoula, MT
  • NPI 1578993531
  NPD
• Missoula Peditric Dentistry, P.C.

  • Pediatric Dentistry
  • Missoula, MT
  • NPI 1205183852
  NPD (past)

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1558308221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST STE D",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017652",
            "telephone_number": "406-541-7337",
            "fax_number": "406-541-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST STE D",
            "address_2": "SUITE B",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017652",
            "telephone_number": "406-541-7334",
            "fax_number": "406-541-7338"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2109 Cuming St",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681024325",
            "country_code": "US",
            "telephone_number": "402-280-5990",
            "fax_number": "402-280-5013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIEDE",
        "first_name": "SUSAN",
        "middle_name": "BON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MT",
            "license": "2151",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NE",
            "license": "5820",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0113191",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE NATIONAL PROVIDER IDENTIFIER",
            "identifier": "1942483524",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• THS, Inc (Advantage Therapy)
• Lorraine Thunstrom, M.S., SLP-CF
• Petra Thysell, MSW
• Jacob Andrew Tiede
• Paul Tiede
• Tigris Nephrology PLLC (Missoula Nephrology)
• Amber J Tillett
• Corine Tilson, LMT
• Tim Cordial PT PC (Cordial Physical Therapy)
• Timberview Family Psychiatry, PLLC

• Pediatric Dentistry in Missoula, MT
• Providers in Missoula, MT by specialty
• Pediatric Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.