| Tidewater Llc | |
|
21534 Great Mills Rd Lexington Park MD 20653-1204 | |
| (301) 862-3900 | |
| (301) 862-3779 |
| Full Name | Tidewater Llc |
|---|---|
| Speciality | Dentist |
| Location | 21534 Great Mills Rd, Lexington Park, 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 21534 Great Mills Rd Lexington Park MD 20653-1204 Ph: (301) 862-3900 |
| NPI Number | 1235642984 |
|---|---|
| Provider Enumeration Date | 11/15/2017 |
| Last Update Date | 11/15/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235642984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Maryland) | Primary |
Tidewater Dental And Assoc Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 21534 Great Mills Rd, Lexington Park, MD 20653 Phone: 301-862-3900 Fax: 301-862-3779 | |
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Jenny O. Hawkins Dds Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 22749 Maple Rd, Lexington Park, MD 20653 Phone: 301-863-8822 | |
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Tidewater Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 21534 Great Mills Rd, Lexington Park, MD 20653 Phone: 301-862-3900 Fax: 301-862-3779 |