Organization
TIDEWATER DENTAL PF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE M MCCABE (OFFICE MANAGER)
(301) 862-3900
Entity
Organization
Contact information
Practice address
690 PRINCE FREDERICK BLVD, PRINCE FREDERICK, MD 20678
(410) 414-8333
(301) 862-3779
Mailing address
690 PRINCE FREDERICK BLVD, PRINCE FREDERICK, MD 20678
(410) 414-8333
(301) 862-3779
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
14501
MD
122300000X
Dentist
Primary
6466
MD
Other
Enumeration date
06/28/2011
Last updated
06/28/2011
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