Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum Organization subpart

Tidewater LLC

General Practice Dentistry in Charlotte Hall, MD · enumerated 2019 · authorized official Simone Wilson, Director of Credentialing & Enroll.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1144884560

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Registry record

Entity type Organization (Type 2)

Legal business name Tidewater LLC

Parent organization Tidewater, LLC

Practice address 30320 Triangle Dr, Charlotte Hall, MD, 20622

Phone (301) 359-1717

Fax (301) 359-1719

Enumeration date May 1, 2019

Last updated in NPPES May 2, 2023

Taxonomy & classification

1223G0001X General Practice Dentistry Dental Providers Primary

Authorized official

Name Simone Wilson

Title Director of Credentialing & Enroll

Phone (848) 326-8840

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

Where is Tidewater LLC located?

The practice location on file with NPPES is in Charlotte Hall, MD.

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2023-05-02. Verify at npiregistry.cms.hhs.gov.

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2023-05-02.