Tidewater LLC

NPI #1518470251 in Lexington Park, Maryland

Provider Information

NPI Number: 1518470251
Entity Type: Organization
Organization Name: Tidewater LLC
Primary Specialty: Dentist
Enumeration Date: Nov 15, 2017
Last Updated: Nov 15, 2017

Practice Location

Address: 21534 GREAT MILLS RD
City: Lexington Park
State: Maryland
ZIP Code: 20653-1204
Phone: (301) 862-3900

Authorized Official

Name: DR. DAVID COOPER, DDS
Title: OWNER
Phone: (301) 862-3900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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