Tidewater Dental Pf
NPI 1053607002ActiveOrganization· Dentist· Prince Frederick, MD
Dentist in Prince Frederick, Maryland, registered in NPPES in June 2011. The authorized official on file is Connie M. McCabe, Office Manager.
Overview
| NPI | 1053607002 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 28, 2011 |
| Last updated in NPPES | Jun 28, 2011 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | 6466 | MD |
| Dentist | 122300000X | 14501 | MD |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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