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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