Organization
TIDEWATER DENTAL SOLOMONS ISLAND, 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
14532 SOLOMONS ISLAND ROAD, SOLOMONS ISLAND, MD 20688
(301) 862-3900
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
MD6466
MD
Other
Enumeration date
09/23/2014
Last updated
09/23/2014
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