Provider Demographics
NPI:1295599686
Name:CPDG-CANTON LLC
Entity type:Organization
Organization Name:CPDG-CANTON LLC
Other - Org Name:
Other - Org Type:
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:410-979-4483
Mailing Address - Street 1:3400 BOX HLL CORP CTR DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1290
Mailing Address - Country:US
Mailing Address - Phone:410-569-4300
Mailing Address - Fax:
Practice Address - Street 1:3904 BOSTON ST STE 104
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5762
Practice Address - Country:US
Practice Address - Phone:410-569-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty