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Contact Information

TIDEWATER DENTAL PF
690 PRINCE FREDERICK BLVD
PRINCE FREDERICK, MD20678
 Phone: 410-414-8333
 Fax: 301-862-3779
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for TIDEWATER DENTAL PF

NPI Number 1053607002
LBN Legal business name TIDEWATER DENTAL PF
Authorized official CONNIE MCCABE - (OFFICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 06/28/2011
Last updated 06/28/2011 - About 15 years ago
Identifiers
MD License # 14501
MD License # 6466
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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