TIDEWATER DENTAL PF (NPI# 1053607002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053607002 |
| Entity Type | Organization |
| Organization Name | TIDEWATER DENTAL PF |
| Practice Address |
690 Prince Frederick Blvd Prince Frederick MD 20678 |
| Practice Telephone | 4104148333 |
| Practice Fax Number | 3018623779 |
| Mailing Telephone | 4104148333 |
| Mailing Fax Number | 3018623779 |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |
| Authorized Official Name | MRS. CONNIE M MCCABE (OFFICE MANAGER) |
| Authorized Official Telephone | 3018623900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 14501 | MD | Dental Providers |
| Y | 122300000X | Dentist | 6466 | MD | Dental Providers |
| Street Address |
690 PRINCE FREDERICK BLVD |
| City | PRINCE FREDERICK |
| State | MD |
| Zip Code | 20678 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902258940 | Chesapeake Orthodontics, LLC | Dentist | 690 Prince Frederick Blvd, Prince Frederick, MD 20678-3146 | 2016-07-01 |
| 1528429321 | Jim Lee, LLC | Dentist | 690 Prince Frederick Blvd, Prince Frederick, MD 20678-3146 | 2016-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861857500 | Watershed Counseling Service | Counselor | 246 Merrimac Court, Prince Frederick, MD 20678 | 2015-12-23 |
| 1023449642 | Mary Gordon Walter | Registered Nurse | 976 Solomans Island Road, Prince Frederick, MD 20678 | 2013-12-07 |
| 1891126827 | Jacqueline Leclercq | Nurse Practitioner | 110 Hospital Road Suite 303, Prince Frederick, MD 20678 | 2013-12-02 |
| 1174959001 | Linsey Rowe Heane | Physical Therapist | 110 Main Street Suite 1, Prince Frederick, MD 20678 | 2013-09-24 |
| 1033411558 | Sharon Patricia Parran | Pharmacist | 80 W.dares Beach Road, Prince Frederick, MD 20678 | 2010-12-04 |
| 1366684326 | Prince Frederick Surgery Center LLC | Clinic/Center | 70 Sherry Lane, Suite 101, Prince Frederick, MD 20678 | 2009-04-06 |
| 1982844734 | Orthocare Solutions Inc | Durable Medical Equipment & Medical Supplies | 220 Old Solomans Island Rd, Prince Frederick, MD 20678 | 2009-03-05 |
| 1225273519 | Rebecca Lynn Jahed | Audiologist | 3180 Blackberry Lane, Prince Frederick, MD 20678 | 2008-12-16 |
| 1669639209 | Ralph Walter Niemann | Dentist | 272 Merrimac Court, Prince Frederick, MD 20678 | 2008-05-21 |
| 1497944888 | Dr. Saleh & Associates, LLC | Psychiatry & Neurology | 110 Hospital Rd., Suite 302, Prince Frederick, MD 20678 | 2007-10-22 |
| Find all providers in zip 20678 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851885131 | Mariela Gaughan | Dentist | 205 Steeple Chase Dr Ste 208, Prince Frederick, MD 20678 | 2018-06-19 |
| 1306359054 | Tidewater LLC | Dentist | 700 Prince Frederick Blvd, Prince Frederick, MD 20678-3141 | 2017-11-15 |
| 1235683152 | Adrienne Grant | Dentist | 205 Steeple Chase Dr, Suite 208, Prince Frederick, MD 20678-4053 | 2016-08-09 |
| 1124352786 | Paula A. Walker | Dentist | 100 Hospital Rd, Calvert Community Dental, Prince Frederick, MD 20678-4017 | 2009-09-29 |
| 1861564882 | Sonia Saddaf Ahsan | Dentist | 205 Steeple Chase Dr, Ste. 208, Prince Frederick, MD 20678-4053 | 2006-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053918862 | Munder Omran Ben-omran | Dentist | 18535 Boysenberry Dr Apt 319, Gaithersburg, MD 20879-3690 | 2020-10-05 |
| 1982210423 | Kevin Wang | Dentist | 1057 W Perimeter Rd, Prince County, MD 20762 | 2020-09-21 |
| 1720692262 | Amanda Amaro | Dentist | 9408 Bruce Dr, Silver Spring, MD 20901-4812 | 2020-09-02 |
| 1790396927 | Kyle Westbrook | Dentist | 614 Eastern Shore Dr Ste D, Salisbury, MD 21804-5940 | 2020-08-12 |
| 1235749417 | Hanin Al-rubai | Dentist | 9936 Shelburne Ter Apt 101, Gaithersburg, MD 20878-5351 | 2020-08-03 |
| 1750999736 | Kyung Min Shin | Dentist | 11 S Eutaw St Apt 1609, Baltimore, MD 21201-1638 | 2020-07-16 |
| 1679181846 | Eric J Guida | Dentist | 832 Locust Dr, West River, MD 20778-9745 | 2020-07-14 |
| 1649897935 | Cory Kyser | Dentist | 1900 E Northern Pkwy Ste 103, Baltimore, MD 21239-2109 | 2020-07-02 |
| 1538786181 | Amstrong Njinguet | Dentist | 823 Booker Dr, Capitol Heights, MD 20743-1833 | 2020-06-30 |
| 1063038339 | Patrick Campbell | Dentist | 8300 Wisconsin Ave Apt 511, Bethesda, MD 20814-3194 | 2020-06-22 |
| Find all providers with the same taxonomy | ||||
| City | PRINCE FREDERICK |
| Zip Code | 20678 |
Please comment or provide details below to improve the information on TIDEWATER DENTAL PF.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.