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Organization
TIDEWATER LLC
Active
Organization
TIDEWATER LLC
Active
Parent organization
TIDEWATER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TIDEWATER LLC
Authorized official
DR. DAVID COOPER DDS (OWNER)
(301) 862-3900
Entity
Organization
Contact information
Practice address
700 PRINCE FREDERICK BLVD, PRINCE FREDERICK, MD 20678-3141
(410) 414-8333
(240) 652-8797
Mailing address
21534 GREAT MILLS RD, LEXINGTON PARK, MD 20653-1204
(301) 862-3900
(301) 862-3779
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
MD
Other
Enumeration date
11/15/2017
Last updated
11/15/2017
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