Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Brock Fred Tidstrom, DDS

Individual provider General Practice Dentistry · NPI 1184065435

Dr. Brock Fred Tidstrom, DDS is a General Practice Dentistry in Fairbanks, Alaska. Licensed in Alaska. Registered with an NPI since 2013.

Licensed in
AK
In the registry since
2013
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

3112 Airport Way Ste 1
Fairbanks, AK 99709-4754
Phone: (907) 452-1250
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 1505 (AK)

Record details

NPI number1184065435
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorNo
NPI enumeratedJuly 16, 2013
Last updated in NPPESJuly 16, 2013
Mailing address3112 Airport Way, Suite 1, Fairbanks, AK 99709-4754

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