Tidwell Smiles PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TIDWELL SMILES PLLC

Practice address

9415 Mesa Dr Ste B
Houston, TX 77028-1202

Phone

(832) 369-6775

Fax

(682) 222-1093

NPI assigned

Dec 1, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Harry Luther

Title

Credentialing Coordinator

Phone

(832) 369-6775

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1952906604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3838 N SAM HOUSTON PKWY E STE 430",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770323418",
            "telephone_number": "832-369-6775",
            "fax_number": "682-222-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9415 MESA DR STE B",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770281202",
            "telephone_number": "832-369-6775",
            "fax_number": "682-222-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDWELL SMILES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-01",
        "last_updated": "2021-06-23",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "LUTHER",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "832-369-6775",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tid Dental PLLC
• Eric Tidline
• Tidwell Dental and Orthodontics PLLC
• Tidwell Hospitalist Services, PA
• Tidwell Profession Pharmacy Inc
• Anna Caroline Tidwell, COTA
• Jenai Tidwell, LPC-S
• Meredith Anderson Tidwell, OTR
• Scott Tidwell, LAT
• Christine Tie, PA-C

• General Practice Dentistry in Houston, TX
• Providers in Houston, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.