OrganizationActive
Tidewater LLC
NPI 1609366756 · Dentist · Lanham, MD
Provider details
- NPI number
- 1609366756
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Parent organization
- Tidewater LLC
- Organization subpart
- Yes
- Authorized official
- David Cooper, Owner(301) 862-3900
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(68/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 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
2830 Campus Way N Ste 614
Lanham, MD 20706-1669
Phone: (301) 955-9198
Fax: (301) 955-9199
Street-level locationGet directions
Mailing address
21534 Great Mills Rd
Lexington Park, MD 20653-1204
Registry dates
- Enumerated
- 2018-05-15
- Last updated
- 2018-05-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.