Individual
DR. BRIAN DALE TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2825 WILLETTA ST SW STE A, ALBANY, OR 97321-3846
(541) 928-2301
(541) 928-8493
Mailing address
2825 WILLETTA ST SW STE A, ALBANY, OR 97321-3846
(541) 928-2301
(541) 928-8493
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9084
OR
Other
Enumeration date
05/29/2008
Last updated
05/29/2008
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