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DR. BROCK FRED TIDSTROM DDS
NPI 1184065435
Dentist - General Practice in Fairbanks, AK

Active since July 16, 2013PECOS Enrolled
3112 AIRPORT WAY, SUITE 1, FAIRBANKS, AK 99709(907) 452-1250 Get Directions Write a Review

NPPES record last updated: July 16, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Brock Fred Tidstrom Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BROCK FRED TIDSTROM DDS (NPI 1184065435) is an individual general practice provider in Fairbanks, Alaska, licensed in Alaska (1505) and active in the NPI registry since July 2013. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1184065435
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. BROCK FRED TIDSTROMCredential: DDS
Location Address3112 AIRPORT WAY, SUITE 1Fairbanks, AK 99709-4754
Mailing Address3112 Airport Way, Suite 1Fairbanks, AK 99709-4754 · (907) 452-1250
Phone(907) 452-1250
Sole ProprietorNo
Enumeration DateJuly 16, 2013
✔ NPI 1184065435 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in AK · 1505
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
3112 AIRPORT WAY, Fairbanks, AK 99709
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Brock Fred Tidstrom Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 99709 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$111.57 typical visit price
range $71.33 – $222.64
Typical copayment $27.89 (range $17.83 – $55.66)
Most-billed visit code 99203
Established Patient
$90.40 typical visit price
range $21.84 – $181.48
Typical copayment $22.60 (range $5.46 – $45.37)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHN W SARGENT DDS
Dentist
3112 AIRPORT WAY, STE #1
FAIRBANKS, AK 99709
Fairbanks North Star Borough (907) 452-1250
DR. DANIEL MICHAEL BERGERON DDS
Dentist (General Practice)
3112 AIRPORT WAY, SUITE 2
FAIRBANKS, AK 99709
Fairbanks North Star Borough (907) 456-5600
DR. BRIAN ALAN PARKER D.D.S
Dentist (General Practice)
3112 AIRPORT WAY, SUITE 1
FAIRBANKS, AK 99709
Fairbanks North Star Borough (907) 475-1250
DR. MICHAEL JOHN STOLTZ DMD
Dentist (Oral and Maxillofacial Surgery)
3112 AIRPORT WAY, SUITE 1
FAIRBANKS, AK 99709
Fairbanks North Star Borough (907) 452-1250
FAIRBANKS DENTAL CENTER LLC
Durable Medical Equipment & Medical Supplies (Customized Equipment)
3112 AIRPORT WAY, SUITE 1
FAIRBANKS, AK 99709
Fairbanks North Star Borough (907) 452-1250

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brock Tidstrom's NPI number?

The NPI number for Brock Tidstrom is 1184065435. It was assigned to this individual provider in the NPPES registry on July 16, 2013.

Where is Brock Tidstrom located?

Brock Tidstrom practices at 3112 Airport Way Suite 1, Fairbanks, AK 99709. The listed phone number is (907) 452-1250.

What is Brock Tidstrom's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Brock Tidstrom enrolled in Medicare?

Yes. Brock Tidstrom is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Brock Tidstrom was last updated on July 16, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.