Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tidewater Dental and Assoc Inc

Organization General Practice Dentistry · NPI 1184703803

Tidewater Dental and Assoc Inc is a General Practice Dentistry in Lexington Park, Maryland. Licensed in Maryland. Registered with an NPI since 2006.

Licensed in
MD
In the registry since
2006
Specialties on file
3
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

21534 Great Mills Rd
Lexington Park, MD 20653
Phone: (301) 862-3900
Fax: (301) 862-3779
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence MD6466 (MD)
General Practice Dentistry Taxonomy 1223G0001X · Licence MD13051 (MD)
General Practice Dentistry Taxonomy 1223G0001X · Licence MD13931 (MD)

Record details

NPI number1184703803
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Connie McCabe — Financial Admin · (301) 862-3900
Other names David J Cooper Michael W Owens Hae Sook Kim
NPI enumeratedNovember 3, 2006
Last updated in NPPESJuly 1, 2008
Mailing address21534 Great Mills Rd, Lexington Park, MD 20653

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