| Organization Name: | TIDEWATER DENTAL SLEEP THERAPY LLC |
| NPI Number: | 1659657799 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID JACK COOPER (OWNER) |
| Mailing Address: | 21534 Great Mills Rd Lexington Park |
| State: | MD US |
| Postal Code: | 206531204 |
| Phone Number: | 3018623900 |
| Fax Number: | 8662415211 |
| NPI Enumeration Date: | 11/02/2011 |
| NPI Last Update Date: | 11/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |