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DR. KYLE D TIDSTROM D.D.S.
NPI 1659343119
Dentist - Oral and Maxillofacial Surgery in Edina, MN

Active since February 07, 2006PECOS Enrolled
7373 FRANCE AVE S, SUITE 602, EDINA, MN 55435(952) 835-5003(952) 835-9598 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Kyle D Tidstrom D.d.s. NPPES

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

DR. KYLE D TIDSTROM D.D.S. (NPI 1659343119) is an individual oral and maxillofacial surgery provider in Edina, Minnesota, licensed in Minnesota (D10340) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1659343119
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. KYLE D TIDSTROMCredential: D.D.S.
Location Address7373 FRANCE AVE S, SUITE 602Edina, MN 55435-4534
Mailing Address7373 France Ave S, Suite 602Edina, MN 55435-4534 · (952) 835-5003
Phone(952) 835-5003
Fax(952) 835-9598
Sole ProprietorNo
Enumeration DateFebruary 7, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1659343119 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in MN · D10340
Definition
An oral and maxillofacial surgery dentist specialized in 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.
7373 FRANCE AVE S, Edina, MN 55435
Open in Google Maps ↗

Other Identifiers 3

Other41677TIFM · Bcbs Number
Other86-17290MN · Medica Number
Medicare UPINT78373MN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kyle D Tidstrom D.d.s. 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.

Medicare Billing Reassignment

Medicare enrollment records show Kyle Tidstrom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Oral And Maxillofacial Surgical Consultants PA
Same address
Oral and Maxillofacial Surgery
7373 FRANCE AVE S, SUITE 602
Edina, MN 55435
  • Reassigned Medicare billing, Minnesota enrollment
  • 15 clinicians in this Medicare group
NPI 1619049921 (952) 835-5003

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55435 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
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
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 20

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

DR. ALLEN LESTER VANBEEK M.D.
Plastic Surgery
7373 FRANCE AVE S, SUITE 510
EDINA, MN 55435
Hennepin County (952) 830-1028
INTEGRATED PROVIDER GROUP OF MINNESOTA
Chiropractor
7373 FRANCE AVE S
EDINA, MN 55435
Hennepin County (877) 414-2533
DR. ANDREW GRAHAM PEARSON DDS
Dentist (Oral and Maxillofacial Surgery)
7373 FRANCE AVE S, SUITE 602
EDINA, MN 55435
Hennepin County (952) 835-5003
MARJORIE L VAN DER HAGEN PA-C
Physician Assistant
7373 FRANCE AVE S, SUITE 312
EDINA, MN 55435
Hennepin County (952) 832-0076
WENDY RENEE GROSS R.N.
Clinical Nurse Specialist
7373 FRANCE AVE S, SUITE 312
EDINA, MN 55435
Hennepin County (952) 832-0076
JOSEPH THOMAS TEYNOR M.D.
Orthopaedic Surgery (Sports Medicine)
7373 FRANCE AVE S, SUITE 312
EDINA, MN 55435
Hennepin County (952) 832-0076
ROBERT J WALKOWSKI PAC
Physician Assistant (Medical)
7373 FRANCE AVE S, 202 CENTENNIAL LAKES MEDICAL CENTER
EDINA, MN 55435
Hennepin County (952) 985-8100
SHARI ANN FAHEY PA-C
Physician Assistant
7373 FRANCE AVE S, SUITE 312
EDINA, MN 55435
Hennepin County (952) 832-0076

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 Kyle Tidstrom's NPI number?

The NPI number for Kyle Tidstrom is 1659343119. It was assigned to this individual provider in the NPPES registry on February 7, 2006.

Where is Kyle Tidstrom located?

Kyle Tidstrom practices at 7373 France Ave S Suite 602, Edina, MN 55435. The listed phone number is (952) 835-5003.

What is Kyle Tidstrom's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Kyle Tidstrom enrolled in Medicare?

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

Which organization bills Medicare for Kyle Tidstrom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kyle Tidstrom reassigns Medicare benefits to Oral And Maxillofacial Surgical Consultants PA (Edina, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kyle Tidstrom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kyle Tidstrom accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Kyle Tidstrom as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kyle Tidstrom was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.