| Tidewater Llc | |
|
2830 Campus Way N Ste 614 Lanham MD 20706-1669 | |
| (301) 955-9198 | |
| (301) 955-9199 |
| Full Name | Tidewater Llc |
|---|---|
| Speciality | Dentist |
| Location | 2830 Campus Way N Ste 614, Lanham, Maryland |
| Authorized Official Name and Position | David Cooper (OWNER) |
| Authorized Official Contact | 3018623900 |
| 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 2830 Campus Way N Ste 614 Lanham MD 20706-1669 Ph: (301) 955-9198 |
| NPI Number | 1609366756 |
|---|---|
| Provider Enumeration Date | 05/15/2018 |
| Last Update Date | 05/15/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609366756 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Maryland) | Primary |
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