DR. BILL SHAYNE TIDWELL (NPI# 1053391797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053391797 |
| Entity Type | Individual |
| Full Name | DR. BILL SHAYNE TIDWELL |
| Credential | DDS |
| Practice Address |
Corner of Route N12 and N7 Fort Defiance AZ 86504-0589 |
| Mailing Address |
Po Box 1801 Fort Defiance AZ 86504-1801 |
| Practice Telephone | 9287298000 |
| Mailing Telephone | 9287298000 |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2019-10-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
117592 | AK | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
7367 | CO | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
14581 | TX | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
6993 | KS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 100454590A | 05 | |
| FEDERAL EMPLOYER NUMBER | 48-1181104 | 01 |
| Street Address |
CORNER OF ROUTE N12 AND N7 |
| City | FORT DEFIANCE |
| State | AZ |
| Zip Code | 86504-0589 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326040577 | John R Thompson | Orthopaedic Surgery | Corner of Route N12 and N7, Fort Defiance, AZ 86504 | 2005-06-01 |
| 1194348524 | Shanna Michelle George | Respiratory Therapist, Registered | Corner of Route N12 and N7, Fort Defiance, AZ 86504-0589 | 2020-05-20 |
| 1265077267 | Stanislava Manojlovic | Pharmacist | Corner of Route N12 and N7, Fort Defiance Indian Hospital Board, Inc., Fort Defiance, AZ 86504-0649 | 2019-11-13 |
| 1033767371 | Dakota Kay | Physical Therapist | Corner of Route N12 and N7, Fort Defiance, AZ 86504-0649 | 2019-08-29 |
| 1053964452 | Jenny Dietz | Nurse Practitioner | Corner of Route N12 and N7, Fort Defiance, AZ 86504 | 2019-07-24 |
| 1386296648 | Tessa Tahereh Facer | Physician Assistant | Corner of Route N12 and N7, Fort Defiance, AZ 86504-0649 | 2019-07-16 |
| 1346892056 | Amanda Barnes | Physician Assistant | Corner of Route N12 and N7, Fort Defiance, AZ 86504-0649 | 2019-07-12 |
| 1295206779 | Craig Amidon Fox | Physical Therapist | Corner of Route N12 and N7, Fort Defiance, AZ 86504 | 2018-12-10 |
| 1134698517 | Christa Lee | Advanced Practice Midwife | Corner of Route N12 and N7, Fort Defiance, AZ 86504-0649 | 2018-11-15 |
| 1518440007 | Ethan Curleyhair | Dentist | Corner of Route N12 and N7, Fort Defiance, AZ 86504 | 2018-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807664 | Clifford Charles | Pharmacist | Corners of Route 7&12, Fort Defiance, AZ 86504 | 2020-10-06 |
| 1720605207 | Christopher A Will | Registered Nurse | 2126-1 Shandiin Circle, Fort Defiance, AZ 86504 | 2020-06-30 |
| 1750904207 | Crystal Salaz | Respiratory Therapist, Registered | Corner of Roue N12 and N7, Fort Defiance, AZ 86504 | 2020-05-19 |
| 1003451600 | Rebecca Reeve | Pharmacist | Tsehootsooi Medical Center, Corner of Indian Route 7 and 12, Fort Defiance, AZ 86504 | 2019-11-07 |
| 1851947485 | David Glen Webb | Pharmacist | Hwy 12 Nr 110, Fort Defiance, AZ 86504 | 2019-08-09 |
| 1952963647 | Eukerison Bobby Tsinajinie | Counselor | .25 Miles S Fieldhouse Ra 6905, Fort Defiance, AZ 86504 | 2019-07-02 |
| 1770145567 | Joann Tso I | Counselor | 1/4 Mile Ne of Ft. Defiance Fieldhouse, Ft. Defiance, AZ 86504 | 2019-07-02 |
| 1174185961 | James Leslie | Counselor | 1/4 Mile South of Ft Defiance Fieldhouse Ra#6905, Ft Defiance, AZ 86504 | 2019-07-02 |
| 1184192163 | Miranda Frances Blatchford | Social Worker | .5 Miles Sw of The Fd Field House, Bldg #6905, Fort Defiance, AZ 86504 | 2018-11-07 |
| 1477030914 | Michelle Rosario | Dietitian, Registered | Fort Defiance Indian Hospital Board, Inc., Corner of Route N12 and N7, Fort Defiance, AZ 86504 | 2018-07-27 |
| Find all providers in zip 86504 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518440007 | Ethan Curleyhair | Dentist | Corner of Route N12 and N7, Fort Defiance, AZ 86504 | 2018-09-11 |
| 1811470776 | Shane Curleyhair | Dentist | Corner of Route N12 and N7, Fort Defiance, AZ 86504 | 2018-09-07 |
| 1154684686 | Jeannie S Yoon | Dentist | Corner of Route N12 and N7, Fort Defiance, AZ 86504-0589 | 2012-06-19 |
| 1720121734 | David Allen Fleming | Dentist | Corner of Route N12 and N7, Fort Defiance, AZ 86504 | 2007-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376616 | Arizona Dental Professionals, P.C. | Dentist | 37591 N Gantzel Rd, San Tan Valley, AZ 85140-7376 | 2020-11-05 |
| 1851992879 | Arizona Dental Professionals, P.C. | Dentist | 1177 S Watson Rd Ste 107, Buckeye, AZ 85326-3465 | 2020-11-05 |
| 1609475060 | Happy Molar Dental LLC | Dentist | 67 N Dobson Rd Ste A-104, Mesa, AZ 85201-6822 | 2020-10-18 |
| 1679171151 | Diana Kim | Dentist | 15128 W Bell Rd Ste 12, Surprise, AZ 85374-2451 | 2020-10-15 |
| 1366040057 | Hdp Casa Grande Dental LLC | Dentist | 1968 N Peart Rd Ste 22, Casa Grande, AZ 85122-2497 | 2020-10-14 |
| 1871191197 | Dentalpros, LLC | Dentist | 225 E Valencia Rd Ste 135, Tucson, AZ 85706-6866 | 2020-10-09 |
| 1457958928 | Eesha Katarya | Dentist | 1060 S Harrison Rd Ste 110, Tucson, AZ 85748-6603 | 2020-10-07 |
| 1063019669 | Sona Dds PC | Dentist | 10450 E. Riggs Rd. #118, Chandler, AZ 85248 | 2020-10-06 |
| 1598362105 | Sona Dds PC | Dentist | 995 E Ocotillo Rd Ste 3, Chandler, AZ 85249-3111 | 2020-10-06 |
| 1205441136 | Maryvale Dental Studio | Dentist | 7614 W Indian School Rd # 2, Phoenix, AZ 85033-3035 | 2020-09-08 |
| Find all providers with the same taxonomy | ||||
| City | FORT DEFIANCE |
| Zip Code | 86504 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.