DR. KYLE D TIDSTROM (NPI# 1659343119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659343119 |
| Entity Type | Individual |
| Full Name | DR. KYLE D TIDSTROM |
| Credential | D.D.S. |
| Practice Address |
7373 France Ave S Suite 602 Edina MN 55435-4534 |
| Practice Telephone | 9528355003 |
| Practice Fax Number | 9528359598 |
| Mailing Telephone | 9528355003 |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D10340 | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MEDICA NUMBER | 86-17290 | 01 |
| FM | BCBS NUMBER | 41677TI | 01 |
| Street Address |
7373 FRANCE AVE S SUITE 602 |
| City | EDINA |
| State | MN |
| Zip Code | 55435-4534 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700880754 | Steven F Noran | Psychiatry & Neurology | 7373 France Ave S, Ste 604, Edina, MN 55435-4552 | 2005-06-08 |
| 1851903124 | Lee Ward Schaefer | Psychologist | 7373 France Ave S, Edina, MN 55435-4451 | 2020-08-18 |
| 1558801357 | Tattoo Removal Shop | Emergency Medicine | 7373 France Ave S, Suite 504, Edina, MN 55435-4549 | 2017-02-28 |
| 1649717778 | Great Lakes Neurobehavioral Center, PC | Psychologist | 7373 France Ave S, Suite 305, Edina, MN 55435-4534 | 2017-01-27 |
| 1629401419 | Daniel Douglas Swatfager | Physical Therapist | 7373 France Ave S, Edina, MN 55435-4534 | 2013-08-15 |
| 1578901294 | Kelly Reed | Physical Therapist | 7373 France Ave S, Edina, MN 55435-4534 | 2013-06-05 |
| 1215372297 | Nirmal Kharel | Family Medicine | 7373 France Ave S, Suite 202, Edina, MN 55435-4534 | 2013-05-06 |
| 1851645071 | Sandra Jean Gress | Physical Therapist | 7373 France Ave S, Edina, MN 55435-4534 | 2012-11-09 |
| 1457608267 | Kristine Dahlheimer Alme | Physical Therapist | 7373 France Ave S, Edina, MN 55435-4534 | 2012-08-10 |
| 1235492059 | Bradley Marc Sundick | Dentist | 7373 France Ave S, Suite 602, Edina, MN 55435-4534 | 2012-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104433416 | Evy Christine Claussen | Social Worker | 6363 France Ave. S., Edina, MN 55435 | 2020-09-30 |
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1730651639 | Taylor Lee Kehoe | Physician Assistant | 7400 France Ave., Suite #100, Edina, MN 55435 | 2018-12-18 |
| 1538666326 | Amanda Deangelo | Physical Therapist | 6401 Southdale Hospital, Ll3g, Edina, MN 55435 | 2018-04-09 |
| 1982107876 | Julia Seliber | Dental Hygienist | 7600 France Ave.s. Suite 1100, Edina, MN 55435 | 2018-03-16 |
| 1154840064 | Southhealth Asc, LLC | Clinic/Center | 4100 Minnesota Drive, Edina, MN 55435 | 2017-09-12 |
| 1730605528 | Edina Medical Supplies | Durable Medical Equipment & Medical Supplies | 7455 France Ave., #614 S, Edina, MN 55435 | 2017-08-14 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1306206321 | Barb Ryan | Mechanotherapist | 7550 France Avenue S, #220, Edina, MN 55435 | 2016-03-03 |
| Find all providers in zip 55435 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689807901 | Jonathan Thomas Misner | Dentist | 5130 Lincoln Dr, Edina, MN 55436-1010 | 2009-09-03 |
| 1235492059 | Bradley Marc Sundick | Dentist | 7373 France Ave S, Suite 602, Edina, MN 55435-4534 | 2012-06-18 |
| 1275892218 | Edina Oral and Maxillofacial Surgery, P.a. | Dentist | 6545 France Ave S, Suite 690, Edina, MN 55435-2131 | 2012-05-11 |
| 1427367531 | Minnesota Oral & Maxillofacial Surgery, P.a. | Dentist | 6545 France Ave S, Suite 690, Edina, MN 55435-2131 | 2010-10-07 |
| 1043476054 | Andrew Graham Pearson | Dentist | 7373 France Ave S, Suite 602, Edina, MN 55435-4534 | 2008-07-30 |
| 1215104534 | Jennifer Lynn Beaudin | Dentist | 7373 France Ave S, Suite 602, Edina, MN 55435-4534 | 2008-05-15 |
| 1720148687 | Todd Christopher Gerlach | Dentist | 6545 France Ave S, Edina, MN 55435-2131 | 2006-12-11 |
| 1619049921 | Oral and Maxillofacial Surgical Consultants Pa | Dentist | 7373 France Ave S, Suite 602, Edina, MN 55435-4534 | 2006-11-14 |
| 1801869045 | Frederick J Haas | Dentist | 7373 France Ave S, Suite 602, Edina, MN 55435-4534 | 2006-02-08 |
| 1609849850 | Stephen R Gulbrandsen | Dentist | 7373 France Ave S, Suite 602, Edina, MN 55435-4534 | 2006-02-08 |
| Find all providers in EDINA | ||||
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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.