Tidewater LLC

NPI #1598278236 in Solomons, Maryland

Provider Information

NPI Number: 1598278236
Entity Type: Organization
Organization Name: Tidewater LLC
Subpart: Yes (part of a larger organization)
Parent Organization: TIDEWATER LLC
Primary Specialty: Dentist
Enumeration Date: Nov 15, 2017
Last Updated: Nov 15, 2017

Practice Location

Address: 14532 SOLOMONS ISLAND RD S
City: Solomons
State: Maryland
ZIP Code: 20688-3206
Phone: (410) 394-6690

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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DR. Douglas La Roi Risk, DDS	Dentist	Solomons	AI Deep Dive
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Organizations

Provider Name	Specialty	City
Tidewater LLC Part of Tidewater LLC	Dentist	Solomons	AI Deep Dive

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