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

Tidewater LLC

Organization Dentist · NPI 1760171060

Tidewater LLC is a Dentist in Glen Burnie, Maryland. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

1720 Crain Hwy S Ste 103
Glen Burnie, MD 21061-5631
Phone: (410) 761-0095
Show map & directions

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

Specialties & licences

Dentist (primary) Taxonomy 122300000X

Record details

NPI number1760171060
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationTidewater, LLC
Authorized official Simone Wilson-Adeleke — Director Of Credentialing & Enroll · (848) 326-8840
NPI enumeratedMay 2, 2023
Last updated in NPPESMay 2, 2023
Certification dateMay 2, 2023
Mailing address21534 Great Mills Rd, Lexington Park, MD 20653-1204

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