Individual
JAMIE RENEE TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDH
Contact information
Practice address
703 W PARK ST, CAYUGA, IN 47928-8207
(765) 492-8099
(765) 492-9048
Mailing address
PO BOX 209, CAYUGA, IN 47928-0209
(765) 492-8099
(765) 492-9048
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13005947A
IN
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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