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TOM RICHARD LIDAHL D.M.D.

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1720081201

Individual Registrant:
 TOM RICHARD LIDAHL D.M.D.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
223 N MAIN ST  PLENTYWOOD, MT 59254-1843 US
Tel: 406-765-2700  Fax: 406-765-1514

Contact information for business:
223 N MAIN ST  PLENTYWOOD, MT 59254-1843 US
Tel: 406-765-2700  Fax: 406-765-1514

Registration Information:
NPI: 1720081201
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
X1223G0001XDental Providers
Dentist
General Practice
MT1327
X122300000XDental Providers
Dentist
MND10463

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
CHIP PROVIDER NUMBER5510244MT01
BCBS PROVIDER NUMBER991068ND01
BCBS PROVIDER NUMBER13274MT01
0116792MT05




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