TIDEWATER LLC
NPI 1760171060
Dentist in Glen Burnie, MD

Active since May 02, 2023
1720 CRAIN HWY S STE 103, GLEN BURNIE, MD 21061(410) 761-0095 Get Directions Write a Review

NPPES record last updated: May 2, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

  • Organization
  • Dentist

About TIDEWATER LLC

This page provides the complete NPI Profile along with additional information for Tidewater Llc, a provider established in Glen Burnie, Maryland operating as a Dentist. The healthcare provider is registered in the NPI registry with number 1760171060 assigned on May 2023. The practitioner's primary taxonomy code is 122300000X. The provider is registered as an organization and their NPI record was last updated 3 years ago. Tidewater Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Simone Wilson-adeleke (Director Of Credentialing & Enroll)

NPI
1760171060 Verify this NPI
Provider Name
TIDEWATER LLC
Entity Type
Organization
Location Address
1720 CRAIN HWY S STE 103 GLEN BURNIE, MD 21061
Location Phone
(410) 761-0095
Mailing Address
21534 GREAT MILLS RD LEXINGTON PARK, MD 20653
Mailing Phone
(301) 862-3900
Is Sole Proprietor?
No
Is Organization Subpart?
Yes
Enumeration Date
05-02-2023
Last Update Date
05-02-2023
Code Navigator

A dentist like Tidewater Llc is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Dentist

Taxonomy Code
122300000X
Type
Dental Providers
Taxonomy Description
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

SIMONE WILSON-ADELEKE

Authorized Official Title
DIRECTOR OF CREDENTIALING & ENROLL
Authorized Official Phone
(848) 326-8840

Reviews for TIDEWATER LLC

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Other Providers at the Same Location


The following 3 providers are registered at the same or a nearby location.

Dentist (General Practice)
1720 CRAIN HWY S STE 103
GLEN BURNIE, MD 21061
Dentist (General Practice)
1720 CRAIN HWY S STE 103
GLEN BURNIE, MD 21061
Dentist (General Practice)
1720 CRAIN HWY S STE 103
GLEN BURNIE, MD 21061

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1760171060, enumerated as an "organization" on May 02, 2023.

The provider is located at 1720 CRAIN HWY S STE 103 GLEN BURNIE, MD 21061 and the phone number is (410) 761-0095.

Dentist with taxonomy code 122300000X.