Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Tidewater LLC

Organization Dentist · NPI 1609366756

Tidewater LLC provides Dentist services in Lanham, Maryland. Licensed in Maryland. Registered with an NPI since 2018.

Licensed in
MD
In the registry since
2018
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2830 Campus Way N Ste 614
Lanham, MD 20706-1669
Phone: (301) 955-9198
Fax: (301) 955-9199
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X (MD)

Record details

NPI number1609366756
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationTidewater LLC
Authorized official David Cooper — Owner · (301) 862-3900
NPI enumeratedMay 15, 2018
Last updated in NPPESMay 15, 2018
Mailing address21534 Great Mills Rd, Lexington Park, MD 20653-1204

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