Individual
DR. AUSTIN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1082N N NORTHCOUNTY BLVD, PLEASANT GROVE, UT 84062-3400
(801) 756-6048
Mailing address
3040 N CULLEN CT, PLEASANT GROVE, UT 84062-9443
(801) 358-2230
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7421
NV
1223G0001X
General Practice Dentistry
LL-538-20
NV
1223P0221X
Pediatric Dentistry
Primary
12772511-9922
UT
Other
Enumeration date
06/27/2020
Last updated
06/28/2022
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