NPIMap

Organization Active NPI

Tidewater LLC

  • Dentist
  • Prince Frederick, MD
National Provider Identifier
1306359054
Registry record updated Nov 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TIDEWATER LLC
Practice address
700 Prince Frederick Blvd
Prince Frederick, MD 20678-3141
Phone
(410) 414-8333
Fax
(240) 652-8797
NPI assigned
Nov 15, 2017
Organization subpart
Yes
Parent organization
TIDEWATER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2017

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

Authorized official

Name
Dr. David Cooper, DDSNPI 1841452596
Title
Owner
Phone
(301) 862-3900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X MD Primary

Addresses

Primary practice location

700 Prince Frederick Blvd
Prince Frederick, MD 20678-3141

Mailing address

21534 Great Mills Rd
Lexington Park, MD 20653-1204
Phone (301) 862-3900

National Provider Directory

National Provider Directory
Tax ID family
Tidewater LLC9 organizations share this tax ID, including this one
Part of
Tidewater LLC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

700 Prince Frederick Blvd
Prince Frederick, MD 20678
Phone (410) 414-8333

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510704000000",
    "number": "1306359054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21534 GREAT MILLS RD",
            "city": "LEXINGTON PARK",
            "state": "MD",
            "postal_code": "206531204",
            "telephone_number": "301-862-3900",
            "fax_number": "301-862-3779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 PRINCE FREDERICK BLVD",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206783141",
            "telephone_number": "410-414-8333",
            "fax_number": "240-652-8797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIDEWATER LLC",
        "enumeration_date": "2017-11-15",
        "last_updated": "2017-11-15",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-862-3900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prince Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; 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.