Tidewater Llc

LBN: Tidewater Llc
Tidewater Llc is an health care organization with primary practice located at 30320 Triangle Dr , Charlotte Hall MD 20622-4109. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty. Tidewater Llc can be contacted via phone (301) 359-1717, or through Wilson, Simone via phone (848) 326-8840.

Contact Information

Primary practice address
30320 Triangle Dr Charlotte Hall MD 20622-4109
Phone: (301) 359-1717
Fax: (301) 359-1719
Website:
Map and Directions
Authorized official contact:
Name: Wilson, Simone
Phone: (848) 326-8840

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X

Profile Details

NPI number 1144884560
LBN Legal business name Tidewater Llc
DBA Doing business as
Authorized official Wilson, Simone
Entity Organization
Organization subpart 1 Yes
Enumeration date May 1st, 2019
Last updated May 2nd, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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