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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: August 16, 2026.

About Tidewater Llc NPPES

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

TIDEWATER LLC (NPI 1760171060) is a healthcare organization registered as a dentist in Glen Burnie, Maryland and active in the NPI registry since May 2023. The organization lists Simone Wilson-adeleke, Director Of Credentialing & Enroll, as its authorized official.

NPPES Registry Identity

NPI1760171060
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameTIDEWATER LLC
Location Address1720 CRAIN HWY S STE 103Glen Burnie, MD 21061-5631
Mailing Address21534 Great Mills RdLexington Park, MD 20653-1204 · (301) 862-3900
Phone(410) 761-0095
Organization SubpartYesParent: Tidewater, Llc
Authorized OfficialSimone Wilson-adelekeDirector Of Credentialing & Enroll · (848) 326-8840
Enumeration DateMay 2, 2023
NPPES CertifiedMay 2, 2023
✔ NPI 1760171060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
Definition
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.
1720 CRAIN HWY S STE 103, Glen Burnie, MD 21061
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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

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHARLES WANG D.D.S.
Dentist
1720 CRAIN HWY S STE 103
GLEN BURNIE, MD 21061
Anne Arundel County (323) 287-6840
DR. MICKEL NEMAN DMD
Dentist (General Practice)
1720 CRAIN HWY S STE 103
GLEN BURNIE, MD 21061
Anne Arundel County (410) 761-0095
DR ALLAN D SCHULMAN PC
Dentist (General Practice)
1720 CRAIN HWY S STE 103
GLEN BURNIE, MD 21061
Anne Arundel County (410) 761-0095
ALLAN SCHULMAN, D.D.S., PA
Dentist (General Practice)
1720 CRAIN HWY S STE 103
GLEN BURNIE, MD 21061
Anne Arundel County (410) 761-0095

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 1760171060. It was assigned to this organization in the NPPES registry on May 2, 2023.

Where is Tidewater LLC located?

Tidewater LLC is located at 1720 Crain Hwy S Ste 103, Glen Burnie, MD 21061. The listed phone number is (410) 761-0095.

What is Tidewater LLC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

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.