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
21534 GREAT MILLS RD, LEXINGTON PARK, MD 20653-1204
(301) 862-3900
(301) 862-3779
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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