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Organization
TIDEWATER DENTAL SLEEP THERAPY LLC
Active
Organization
TIDEWATER DENTAL SLEEP THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID JACK COOPER DDS (OWNER)
(301) 862-3900
Entity
Organization
Contact information
Practice address
21534 GREAT MILLS RD, LEXINGTON PARK, MD 20653-1204
(301) 862-3900
(866) 241-5211
Mailing address
21534 GREAT MILLS RD, LEXINGTON PARK, MD 20653-1204
(301) 862-3900
(866) 241-5211
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
11/02/2011
Last updated
11/02/2011
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