Tidewater LLC
NPI 1760171060ActiveOrganization· Dentist· Glen Burnie, MD
Dentist in Glen Burnie, Maryland, registered in NPPES in May 2023, part of Tidewater, LLC. The authorized official on file is Simone Wilson-Adeleke, Director Of Credentialing & Enroll.
Overview
| NPI | 1760171060 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Tidewater, LLC |
| NPI issued | May 2, 2023 |
| Last updated in NPPES | May 2, 2023 |
| Certified by provider | May 2, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | — | — |
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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