Organization
TIDEWATER LLC
Active
Parent organization
TIDEWATER, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TIDEWATER, LLC
Authorized official
DAVID COOPER (OWNER)
(301) 862-3900
Entity
Organization
Contact information
Practice address
10113 WARD RD, DUNKIRK, MD 20754-2717
(301) 327-3314
(301) 327-3315
Mailing address
21534 GREAT MILLS RD, LEXINGTON PARK, MD 20653-1204
(301) 862-3900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
MD
Other
Enumeration date
06/14/2018
Last updated
06/14/2018
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