Dr Brock Fred Tidstrom, DDS - Medicare Dentist in Fairbanks, AK

Dr Brock Fred Tidstrom, DDS is a medicare enrolled "Dentist - General Practice" provider in Fairbanks, Alaska. His current practice location is 3112 Airport Way, Suite 1, Fairbanks, Alaska. You can reach out to his office (for appointments etc.) via phone at (907) 452-1250.

Dr Brock Fred Tidstrom is licensed to practice in Alaska (license number 1505) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1184065435.

Contact Information

Dr Brock Fred Tidstrom, DDS
3112 Airport Way, Suite 1,
Fairbanks, AK 99709-4754
(907) 452-1250
Not Available



Healthcare Provider's Profile

Full NameDr Brock Fred Tidstrom
GenderMale
SpecialityDentist - General Practice
Location3112 Airport Way, Fairbanks, Alaska
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1184065435
  • Provider Enumeration Date: 07/16/2013
  • Last Update Date: 07/16/2013
  Medicare PECOS Information:
  • PECOS PAC ID: 4385943901
  • Enrollment ID: I20160504000471

Medical Identifiers

Medical identifiers for Dr Brock Fred Tidstrom such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1184065435NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
1223G0001XDentist - General Practice 1505 (Alaska)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Brock Fred Tidstrom is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Brock Fred Tidstrom, DDS
3112 Airport Way, Suite 1,
Fairbanks, AK 99709-4754

Ph: (907) 452-1250
Dr Brock Fred Tidstrom, DDS
3112 Airport Way, Suite 1,
Fairbanks, AK 99709-4754

Ph: (907) 452-1250

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› Verified 9 days ago


Dentist in Fairbanks, AK

Jeffrey W Kilgore, D.M.D.
Dentist
Medicare: Medicare Enrolled
Practice Location: 1606 23rd Ave, Fairbanks, AK 99701
Phone: 907-455-4567    Fax: 907-458-1589
Walter John Babula, DMD
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 1919 Lathrop St Ste 102, Fairbanks, AK 99701
Phone: 907-452-2939    Fax: 907-451-7330
Dr. Sarah J Satow, BSC., DMD, FRCDC
Dentist
Medicare: Medicare Enrolled
Practice Location: 114 Minnie St.,, Suite D, Fairbanks, AK 99701
Phone: 907-455-4010    
Dr. Henry Charles Jensen,
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 570 Riverstone Way, Suite 1, Fairbanks, AK 99709
Phone: 907-455-4350    
Dr. Matthew Douglas Richards, DDS
Dentist
Medicare: Medicare Enrolled
Practice Location: 122 1st Ave, Ste 600, Fairbanks, AK 99701
Phone: 907-452-8251    
Dr. Melissa Marcella Webster, DMD
Dentist
Medicare: Medicare Enrolled
Practice Location: 421 3rd St, Ste B, Fairbanks, AK 99701
Phone: 907-455-7100    Fax: 907-455-7109
John W Sargent, DDS
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 3112 Airport Way, Ste #1, Fairbanks, AK 99709
Phone: 907-452-1250    Fax: 907-456-1307

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