IndividualActive
Brock Tidstrom, DDS
NPI 1184065435 · General Practice Dentistry · Fairbanks, AK
Provider details
- NPI number
- 1184065435
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- License
- 1505 (AK)
Specialties & taxonomies
Dental Providers
Practice location
3112 Airport Way
Suite 1
Fairbanks, AK 99709-4754
Phone: (907) 452-1250
Approximate (ZIP-level) locationGet directions
Mailing address
3112 Airport Way
Fairbanks, AK 99709-4754
Registry dates
- Enumerated
- 2013-07-16
- Last updated
- 2013-07-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.