Provider Demographics
NPI:1851520886
Name:CHESAPEAKE PEDIATRIC DENTAL GROUP INC
Entity Type:Organization
Organization Name:CHESAPEAKE PEDIATRIC DENTAL GROUP INC
Other - Org Name:CPDG-PH, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOYMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:410-248-3384
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?:Yes
Parent Organization LBN:CHESAPEAKE PEDIATRIC DENTAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-13
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127701223P0221X
MD138891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022999700Medicaid
MD9200608Medicaid
MD026120300Medicaid
MD036344800Medicaid
MD008494860Medicaid