Individual
TOM RICHARD LIDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
223 N MAIN ST, PLENTYWOOD, MT 59254-1843
(406) 765-2700
(406) 765-1514
Mailing address
223 N MAIN ST, PLENTYWOOD, MT 59254-1843
(406) 765-2700
(406) 765-1514
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10463
MN
1223G0001X
General Practice Dentistry
1327
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0116792
—
MT
01
—
13274
BCBS PROVIDER NUMBER
MT
01
—
5510244
CHIP PROVIDER NUMBER
MT
01
—
991068
BCBS PROVIDER NUMBER
ND
Enumeration date
05/27/2005
Last updated
09/11/2025
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