ERIC IVAN TIDWELL

PROVO, UT
NPI1932131562
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: UT  145165)
Enumeration Date2006-07-06
Last Update Date2007-07-08
Business Address
Dr. ERIC IVAN TIDWELL DDS
777 N 500 W STE 101A
PROVO, UT 84601-1594
Phone number: 801-373-6362
Mailing Address
Dr. ERIC IVAN TIDWELL DDS
777 N 500 W STE 101A
PROVO, UT 84601-1594
Phone number: 801-373-6362
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