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NPI 1265059091

IndividualActive

Austin Tidwell, DMD

NPI 1265059091 · Pediatric Dentistry · Pleasant Grove, UT

Provider details

NPI number: 1265059091
Entity type: Individual
Primary specialty: Pediatric DentistryDental Providers
Credential: DMD
Sex: Male
Sole proprietor: Yes
License: 7421 (NV)

Specialties & taxonomies

Pediatric DentistryPrimary1223P0221XLicense 12772511-9922 (UT)
Dental Providers
Dentist122300000XLicense 7421 (NV)
Dental Providers
General Practice Dentistry1223G0001XLicense LL-538-20 (NV)
Dental Providers

Practice location

1082n N Northcounty Blvd

Pleasant Grove, UT 84062-3400

Phone: (801) 756-6048

Approximate (ZIP-level) locationGet directions

More UT providers

Mailing address

3040 N Cullen Ct

Pleasant Grove, UT 84062-9443

Additional practice locations (1)

1001 Shadow Ln # Ms 7423
Las Vegas, NV 89106-4124
Phone: (702) 774-2416

Registry dates

Enumerated: 2020-06-27
Last updated: 2022-06-28
Certified: 2022-06-28

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Austin Tidwell, DMD — NPI 1265059091, Pleasant Grove, UT | NPI Central