Tidewater Dental Solomons Island, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

MD6466 Issued in MD

Legal business name

TIDEWATER DENTAL SOLOMONS ISLAND, LLC

Practice address

14532 Solomons Island Road
Solomons Island, MD 20688

Phone

(301) 862-3900

NPI assigned

Sep 23, 2014

Last updated

Sep 23, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Jack Cooper, DDSNPI 1841452596

Title

Owner

Phone

(301) 862-3900

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• David Jack Cooper, DDS

  • Dentist
  • Lexington PK, MD
  • NPI 1841452596
  Authorized official Same address or phone

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

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1982006888",
    "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": "14532 SOLOMONS ISLAND ROAD",
            "city": "SOLOMONS ISLAND",
            "state": "MD",
            "postal_code": "20688",
            "telephone_number": "301-862-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER DENTAL SOLOMONS ISLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-23",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-862-3900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "MD6466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila Marie Cadiz, COTA
• Calvert Physical Therapy and Sports Fitness Center

• General Practice Dentistry in Solomons Island, MD
• Providers in Solomons Island, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.