Tyler Keith Stidham, DMD, MBA
NPI 1770272163ActiveIndividual· Dentist· Fernandina Beach, FL
Dentist (DMD, MBA) in Fernandina Beach, Florida, licensed in FL and OH, with an NPI issued in May 2023. Part D covered 20 prescriptions written in 2024, 100% of them generic.
Overview
| NPI | 1770272163 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DMD, MBA |
| Sole proprietor | Yes |
| NPI issued | May 2, 2023 |
| Last updated in NPPES | Nov 3, 2025 |
| Certified by provider | Nov 3, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | DN29186 | FL |
| Dentist | 122300000X | 30.027614 | OH |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Part D prescriptions in 2024
| Prescriptions (claims) | 20 · 20 30-day fills |
|---|---|
| Patients | 11 |
| Total drug cost | $61.12 |
| Generic share | 100% of claims |
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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