NPIMap

Organization Active NPI

Tidewater LLC

  • Dentist
  • Lanham, MD
National Provider Identifier
1609366756
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TIDEWATER LLC
Practice address
2830 Campus Way N Ste 614
Lanham, MD 20706-1669
Phone
(301) 955-9198
Fax
(301) 955-9199
NPI assigned
May 15, 2018
Organization subpart
Yes
Parent organization
TIDEWATER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Authorized official

Name
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

2830 Campus Way N Ste 614
Lanham, MD 20706-1669

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

2830 Campus Way N
Ste 614
Lanham, MD 20706
Phone (301) 563-9359

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 5

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": "1526342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1609366756",
    "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": "2830 CAMPUS WAY N STE 614",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207061669",
            "telephone_number": "301-955-9198",
            "fax_number": "301-955-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIDEWATER LLC",
        "enumeration_date": "2018-05-15",
        "last_updated": "2018-05-15",
        "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_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 Lanham, MD

Sources for this page

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