Tidewater Dental PF

Primary specialty

DentistTaxonomy code 122300000X

License

6466 Issued in MD

Legal business name

TIDEWATER DENTAL PF

Practice address

690 Prince Frederick Blvd
Prince Frederick, MD 20678

Phone

(410) 414-8333

Fax

(301) 862-3779

NPI assigned

Jun 28, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Connie M McCabe

Title

Office Manager

Phone

(301) 862-3900

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309219200000",
    "number": "1053607002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 PRINCE FREDERICK BLVD",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "20678",
            "telephone_number": "410-414-8333",
            "fax_number": "301-862-3779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 PRINCE FREDERICK BLVD",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "20678",
            "telephone_number": "410-414-8333",
            "fax_number": "301-862-3779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER DENTAL PF",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-28",
        "last_updated": "2011-06-28",
        "status": "A",
        "authorized_official_last_name": "MCCABE",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "301-862-3900",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "6466",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "14501",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betsy Cordeiro Therrien
• Upeksha Sewwandi Thilakawardana
• Alison Witmer Thir, PSY.D
• Reena Mary Thomas, M.D.
• Jenna Thompson, LCSW-C
• Tidewater LLC
• Joseph R Tiralla, M.D.
• Meghan Duncan Toffey, LCSW-C
• Transitions Counseling, LLC
• David Trimble, MD

• Dentist in Prince Frederick, MD
• Providers in Prince Frederick, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.