Tidewater LLC

Dentist · Lanham, MD

Organization Active NPI

NPI number 1609366756

Practice location

2830 Campus Way N Ste 614
Lanham, MD 20706-1669
Phone
(301) 955-9198
Fax
(301) 955-9199

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NPI record

NPI
1609366756
Entity type
Organization (Type 2)
Enumeration date
May 15, 2018
Last updated
May 15, 2018
Organization subpart
Yes
Parent organization
Tidewater LLC

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Dentist Primary 122300000X — MD

Mailing address

21534 Great Mills Rd
Lexington Park, MD 20653-1204
Phone
(301) 862-3900

Authorized official

Name
David Cooper, DDS
Title
Owner
Phone
(301) 862-3900

About Tidewater LLC

Tidewater LLC is a healthcare organization registered in the NPI registry with the primary taxonomy Dentist (code 122300000X). The practice location is 2830 Campus Way N Ste 614, Lanham, MD 20706-1669. The NPI number 1609366756 was assigned on May 15, 2018 and the record was last updated on May 15, 2018.

The authorized official for this organization is David Cooper, DDS, Owner.

Frequently asked questions

What is the NPI number of Tidewater LLC?

The NPI number is 1609366756.

What is the phone number of Tidewater LLC?

The phone number listed for the practice location is (301) 955-9198.

Where is Tidewater LLC located?

2830 Campus Way N Ste 614, Lanham, MD 20706-1669.

What is the taxonomy code for Tidewater LLC?

The primary taxonomy code is 122300000X – Dentist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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