# TOM RICHARD LIDAHL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1720081201
- **Gender:** Man
- **Credential:** D.M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D10463 | MN | Yes |
| 1223G0001X | General Practice Dentistry | 1327 | MT | — |

## Other

- **Enumeration date:** 05/27/2005
- **Last updated:** 09/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0116792 | — | MT |
| 01 | — | 13274 | BCBS PROVIDER NUMBER | MT |
| 01 | — | 5510244 | CHIP PROVIDER NUMBER | MT |
| 01 | — | 991068 | BCBS PROVIDER NUMBER | ND |