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TIDEWATER LLC
NPI 1144884560
Dentist - General Practice in Charlotte Hall, MD

Active since May 01, 2019
30320 TRIANGLE DR, CHARLOTTE HALL, MD 20622(301) 359-1717(301) 359-1719 Get Directions Write a Review

NPPES record last updated: May 2, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 2, 2023, May 1, 2019 (2 updates tracked since 2019).

About Tidewater Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIDEWATER LLC (NPI 1144884560) is a healthcare organization registered as a general practice in Charlotte Hall, Maryland and active in the NPI registry since May 2019. The organization lists Simone Wilson, Director Of Credentialing & Enroll, as its authorized official.

NPPES Registry Identity

NPI1144884560
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameTIDEWATER LLC
Location Address30320 TRIANGLE DRCharlotte Hall, MD 20622-4109
Mailing Address21534 Great Mills RdLexington Park, MD 20653-1204
Phone(301) 359-1717
Fax(301) 359-1719
Organization SubpartYesParent: Tidewater, Llc
Authorized OfficialSimone WilsonDirector Of Credentialing & Enroll · (848) 326-8840
Enumeration DateMay 1, 2019
Last NPPES UpdateMay 2, 20232 updates tracked since enumeration
NPPES CertifiedMay 2, 2023
✔ NPI 1144884560 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
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.
30320 TRIANGLE DR, Charlotte Hall, MD 20622
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tidewater LLC's NPI number?

The NPI number for Tidewater LLC is 1144884560. It was assigned to this organization in the NPPES registry on May 1, 2019.

Where is Tidewater LLC located?

Tidewater LLC is located at 30320 Triangle Dr, Charlotte Hall, MD 20622. The listed phone number is (301) 359-1717.

What is Tidewater LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Tidewater LLC was last updated on May 2, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.