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Individual
DR. BILL SHAYNE TIDWELL
Active
Individual
DR. BILL SHAYNE TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
117592
AK
1223G0001X
General Practice Dentistry
14581
TX
1223G0001X
General Practice Dentistry
6993
KS
1223G0001X
General Practice Dentistry
7367
CO
1223G0001X
General Practice Dentistry
Primary
DEN.00007367
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100454590A
—
KS
01
—
48-1181104
FEDERAL EMPLOYER NUMBER
—
Enumeration date
01/19/2006
Last updated
10/05/2026
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