Individual
DR. TODD A TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1121 BROAD STREET, SUITE 46, SUMTER, SC 29150
(803) 436-5640
(803) 436-5641
Mailing address
2325 WILLOW OAK DRIVE, COLUMBIA, SC 29223
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3502
SC
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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