Dr Kyle D Tidstrom, DDS in Edina, MN - Medicare Dentist Provider

Dr Kyle D Tidstrom, DDS is a medicare enrolled "Dentist - Oral And Maxillofacial Surgery" provider in Edina, Minnesota. His current practice location is 7373 France Ave S, Suite 602, Edina, Minnesota. You can reach out to his office (for appointments etc.) via phone at (952) 835-5003.

Dr Kyle D Tidstrom is licensed to practice in Minnesota (license number D10340) 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 1659343119.

Contact Information

	Dr Kyle D Tidstrom, DDS
	7373 France Ave S, Suite 602, Edina, MN 55435-4534
	(952) 835-5003
	(952) 835-9598

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Kyle D Tidstrom
Gender	Male
Speciality	Dentist - Oral And Maxillofacial Surgery
Location	7373 France Ave S, Edina, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1659343119
Provider Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007

Medicare PECOS Information:

PECOS PAC ID: 3173500956
Enrollment ID: I20040630000414

Medical Identifiers

Medical identifiers for Dr Kyle D Tidstrom such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1659343119	NPI	-	NPPES
41677TI	Other	FM	BCBS NUMBER
86-17290	Other	MN	MEDICA NUMBER

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1223S0112X	Dentist - Oral And Maxillofacial Surgery	D10340 (Minnesota)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kyle D Tidstrom allows following entities to bill medicare on his behalf.

Entity Name	Oral And Maxillofacial Surgical Consultants Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1316165012 PECOS PAC ID: 2961489844 Enrollment ID: O20040630000218

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 Kyle D 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 Address	Practice Location Address
Dr Kyle D Tidstrom, DDS 7373 France Ave S, Suite 602, Edina, MN 55435-4534 Ph: (952) 835-5003	Dr Kyle D Tidstrom, DDS 7373 France Ave S, Suite 602, Edina, MN 55435-4534 Ph: (952) 835-5003

Reviews and Comments

Dentist in Edina, MN

Steven T Maroney, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 5100 Eden Ave, #209, Edina, MN 55436 Phone: 952-929-0641 Fax: 952-929-1802
Dr. Michele Ann Reynolds, D.D.S.,M.S. Dentist Medicare: Medicare Enrolled Practice Location: 6545 France Ave S, Suite 665 Southdale Medical Building, Edina, MN 55435 Phone: 952-927-8694
Dr. Janet Amy Zingale, D.D.S. Dentist Medicare: Medicare Enrolled Practice Location: 3930 Sunnyside Rd, Edina, MN 55424 Phone: 952-929-9131
Dr. David John Clay, DDS MS Dentist Medicare: Not Enrolled in Medicare Practice Location: 6545 France Ave S, Suite 680, Edina, MN 55435 Phone: 952-922-5326 Fax: 952-922-5367
Robert Luther Bodin, Dentist Medicare: Not Enrolled in Medicare Practice Location: 5100 Eden Ave, Edina, MN 55436 Phone: 952-929-0641
Dr. Mary Elizabeth Johnson, D.D.S. Dentist Medicare: Medicare Enrolled Practice Location: 6545 France Ave S, Suite 665, Edina, MN 55435 Phone: 952-927-8694 Fax: 952-927-8695
Dr. Craig Freeman, DDS Dentist Medicare: Medicare Enrolled Practice Location: 7373 France Ave S Ste 500, Edina, MN 55435 Phone: 952-831-2800

Dr Kyle D Tidstrom, DDS - Medicare Dentist in Edina, MN