Organization
JOHN K TIDWELL DDS PS
Active
Other names
BALLARD ORAL AND MAXILLOFACIAL SURGERY
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH BARNES (MANAGER)
(206) 783-9672
Entity
Organization
Contact information
Practice address
1801 NW MARKET ST, SUITE 108, SEATTLE, WA 98107-3987
(206) 783-9672
Mailing address
1801 NW MARKET ST, SUITE 108, SEATTLE, WA 98107-3987
(206) 783-9672
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DE00006884
WA
Other
Enumeration date
10/22/2013
Last updated
10/22/2013
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