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General NPI Number Information
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NPI Number | 1891043006
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Entity Type | Organization
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Legal Business Name | CPDG-AM
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Dates
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Enumeration Date | 08/17/2012
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 7556 TEAGUE RD SUITE 110
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City | HANOVER
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State | MD
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Zip | 21076-1213
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Country | US
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Telephone | 410-799-0780
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Fax | 410-799-0781
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Provider Business Mailing Address
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Address Line | 7556 TEAGUE RD SUITE 110
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City | HANOVER
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State | MD
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Zip | 21076-1213
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Country | US
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Telephone | 410-799-0780
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Fax | 410-799-0781
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAKAN OMER KOYMEN
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Credential | DDS, MS
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Telephone | 410-248-3384
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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 | 12770
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License Number State | MD
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