# TIDEWATER LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TIDEWATER LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1407369143
- **Legal business name:** TIDEWATER LLC
- **Authorized official:** DR. DAVID COOPER DDS (OWNER)
- **Authorized official phone:** (301) 862-3900

## Contact information

- **Practice address:** 13350 H.G TRUEMAN ROAD, SOLOMONS, MD 20688
- **Practice address phone:** (410) 326-4078
- **Practice address fax:** (410) 326-9311
- **Mailing address:** 21534 GREAT MILLS RD, LEXINGTON PARK, MD 20653-1204
- **Mailing address phone:** (301) 862-3900
- **Mailing address fax:** (301) 862-3779

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | MD | Yes |

## Other

- **Enumeration date:** 11/15/2017
- **Last updated:** 11/23/2020