# JOHN K TIDWELL DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BALLARD ORAL AND MAXILLOFACIAL SURGERY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245668631
- **Authorized official:** ELIZABETH BARNES (MANAGER)
- **Authorized official phone:** (206) 783-9672

## Contact information

- **Practice address:** 1801 NW MARKET ST, SUITE 108, SEATTLE, WA 98107-3987
- **Practice address phone:** (206) 783-9672
- **Mailing address:** 1801 NW MARKET ST, SUITE 108, SEATTLE, WA 98107-3987
- **Mailing address phone:** (206) 783-9672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DE00006884 | WA | Yes |

## Other

- **Enumeration date:** 10/22/2013
- **Last updated:** 10/22/2013