TIDEWATER LLC NPI 1144884560

NPI Information

  • NPI: 1144884560
  • Provider Name: TIDEWATER LLC
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Address: 30320 TRIANGLE DR
    CHARLOTTE HALL, MD
    ZIP 20622
  • Phone: (301) 359-1717

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NPI Details

TIDEWATER LLC is a general practice dentist in Charlotte Hall, MD. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. TIDEWATER LLC NPI is 1144884560. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

30320 TRIANGLE DR
CHARLOTTE HALL, MD
ZIP 20622-109
Phone: (301) 359-1717
Fax: (301) 359-1719

The provider's authorized official is Simone Wilson .
The authorized official title is Director Of Credentialing & Enroll and has the following contact phone number (848) 326-8840.

The enumeration date for this NPI number is 5/1/2019 and was last updated on 5/2/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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