Individual
DR. BROCK FRED TIDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3112 AIRPORT WAY, SUITE 1, FAIRBANKS, AK 99709-4754
(907) 452-1250
Mailing address
3112 AIRPORT WAY, SUITE 1, FAIRBANKS, AK 99709-4754
(907) 452-1250
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1505
AK
Other
Enumeration date
07/16/2013
Last updated
07/16/2013
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