Individual
DR. SCHAVEZ LABANE TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8609 2ND AVE, SUITE 504B, SILVER SPRING, MD 20910-3360
(301) 565-5277
(301) 565-0048
Mailing address
8609 2ND AVE, SUITE 504B, SILVER SPRING, MD 20910-3360
(301) 565-5277
(301) 565-0048
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9209
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09209
DENTIST LICENSE
MD
Enumeration date
06/22/2011
Last updated
06/22/2011
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