| Tidewater Llc | |
|
1720 Crain Hwy S Ste 103 Glen Burnie MD 21061-5631 | |
| (410) 761-0095 | |
| Not Available |
| Full Name | Tidewater Llc |
|---|---|
| Speciality | Dentist |
| Location | 1720 Crain Hwy S Ste 103, Glen Burnie, Maryland |
| Authorized Official Name and Position | Simone Wilson-adeleke (DIRECTOR OF CREDENTIALING & ENROLL) |
| Authorized Official Contact | 8483268840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Llc 21534 Great Mills Rd Lexington Park MD 20653-1204 Ph: (301) 862-3900 | Tidewater Llc 1720 Crain Hwy S Ste 103 Glen Burnie MD 21061-5631 Ph: (410) 761-0095 |
| NPI Number | 1760171060 |
|---|---|
| Provider Enumeration Date | 05/02/2023 |
| Last Update Date | 05/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760171060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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