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General NPI Number Information
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NPI Number | 1295599686
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Entity Type | Organization
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Legal Business Name | CPDG-CANTON LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 3904 BOSTON ST STE 104
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City | BALTIMORE
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State | MD
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Zip | 21224-5762
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Country | US
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Telephone | 410-569-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 BOX HLL CORP CTR DR STE 120
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City | ABINGDON
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State | MD
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Zip | 21009-1290
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Country | US
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Telephone | 410-569-4300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAKAN KOYMEN
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Credential | DDS, MS
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Telephone | 410-979-4483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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