Healthcare Provider Details

I. General information

NPI: 1962167510
Provider Name (Legal Business Name): CPDG-DD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 NORTH POINT BLVD SUITE 101
DUNDALK MD
21222
US

IV. Provider business mailing address

5009 HONEYGO CENTER DR STE 228
PERRY HALL MD
21128-9842
US

V. Phone/Fax

Practice location:
  • Phone: 410-388-8273
  • Fax:
Mailing address:
  • Phone: 410-248-3384
  • Fax: 410-248-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HAKAN OMER KOYMEN
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 410-979-4483