Organization
CPDG-AM
Active
Parent organization
CHESAPEAKE PEDIATRIC DENTAL GROUP, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHESAPEAKE PEDIATRIC DENTAL GROUP, LLC
Authorized official
HAKAN OMER KOYMEN DDS, MS (PRESIDENT)
(410) 248-3384
Entity
Organization
Contact information
Practice address
7556 TEAGUE RD, SUITE 110, HANOVER, MD 21076-1213
(410) 799-0780
(410) 799-0781
Mailing address
7556 TEAGUE RD, SUITE 110, HANOVER, MD 21076-1213
(410) 799-0780
(410) 799-0781
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12770
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008494860
—
MD
05
—
022999700
—
MD
05
—
026120300
—
MD
05
—
036344800
—
MD
05
—
9200608
—
MD
Enumeration date
08/17/2012
Last updated
02/06/2017
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