NPIMap

Organization Active NPI

Tidewater LLC

  • General Practice Dentistry
  • Dunkirk, MD
National Provider Identifier
1437643384
Registry record updated Jun 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TIDEWATER LLC
Practice address
10113 Ward Rd
Dunkirk, MD 20754-2717
Phone
(301) 327-3314
Fax
(301) 327-3315
NPI assigned
Jun 14, 2018
Last updated
Jun 14, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
TIDEWATER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2018

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

Authorized official

Name
David CooperNPI 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
General Practice Dentistry 1223G0001X MD Primary

Addresses

Primary practice location

10113 Ward Rd
Dunkirk, MD 20754-2717

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

10113 Ward Rd
Dunkirk, MD 20754
Phone (252) 443-9097

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528934400000",
    "number": "1437643384",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10113 WARD RD",
            "city": "DUNKIRK",
            "state": "MD",
            "postal_code": "207542717",
            "telephone_number": "301-327-3314",
            "fax_number": "301-327-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIDEWATER, LLC",
        "enumeration_date": "2018-06-14",
        "last_updated": "2018-06-14",
        "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"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunkirk, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; 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.