Provider Demographics
NPI:1093589350
Name:CHESAPEAKE PEDIATRIC DENTAL GROUP, INC
Entity Type:Organization
Organization Name:CHESAPEAKE PEDIATRIC DENTAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAKAN
Authorized Official - Middle Name:OMER
Authorized Official - Last Name:KOYMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:410-979-4483
Mailing Address - Street 1:5002 HONEYGO CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-8962
Mailing Address - Country:US
Mailing Address - Phone:410-248-3384
Mailing Address - Fax:410-248-3385
Practice Address - Street 1:5002 HONEYGO CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-8962
Practice Address - Country:US
Practice Address - Phone:410-248-3384
Practice Address - Fax:410-248-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty