OrganizationActive
Tidewater LLC
NPI 1144884560 · General Practice Dentistry · Charlotte Hall, MD
Tidewater LLC is a General Practice Dentistry organization in Charlotte Hall, MD (NPI 1144884560).
Provider details
- NPI number
- 1144884560
- Entity type
- Organization
- Primary specialty
- General Practice DentistryDental Providers
- Parent organization
- Tidewater, LLC
- Organization subpart
- Yes
- Authorized official
- Simone Wilson, Director of Credentialing & Enroll(848) 326-8840
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(66/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
30320 Triangle Dr
Charlotte Hall, MD 20622-4109
Phone: (301) 359-1717
Fax: (301) 359-1719
Street-level locationGet directions
Mailing address
21534 Great Mills Rd
Lexington Park, MD 20653-1204
Registry dates
- Enumerated
- 2019-05-01
- Last updated
- 2023-05-02
- Certified
- 2023-05-02
Frequently asked questions
- What is Tidewater LLC's NPI number?
- Tidewater LLC's National Provider Identifier (NPI) is 1144884560, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Tidewater LLC?
- Tidewater LLC is classified in the NPPES registry as General Practice Dentistry (Dental Providers).
- Where is Tidewater LLC located?
- Tidewater LLC's practice location on file with NPPES is 30320 Triangle Dr, Charlotte Hall, MD 20622-4109.
- What is Tidewater LLC's phone number?
- The practice phone number listed in the NPPES registry for Tidewater LLC is (301) 359-1717.
- Who is the authorized official for Tidewater LLC?
- The authorized official listed on Tidewater LLC's NPPES record is Simone Wilson, Director of Credentialing & Enroll. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Tidewater LLC's NPI active?
- Yes — Tidewater LLC's NPI (1144884560) is active in the NPPES registry as of the last update on 2023-05-02.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.