Tiedje, Larry G

Tiedje, Larry G is an individual health care provider with primary practice located at 2410 Pierce St , Sioux City IA 51104-3724. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Tiedje, Larry G can be contacted via phone (712) 255-9056.

Contact Information

Primary practice address
2410 Pierce St Sioux City IA 51104-3724
Phone: (712) 255-9056
Fax: (712) 255-1526
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 05957 Iowa

Profile Details

NPI number 1821046897
LBN Legal business name Tiedje, Larry G
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821046897 NPPES
Iowa Other 099-853 DELTA DENTAL IOWA
Iowa MEDICAID 0087882 DELTA DENTAL IOWA
Iowa Other 702-363 DELTA DENTAL IOWA

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