NPIMap

Individual provider Active NPI

Sandra Kouyoumjian, DDS

  • General Practice Dentistry
  • Fayetteville, NC
National Provider Identifier
1053832683
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11198 Issued in NC
Practice address
5075 Morganton Rd Ste 12
Fayetteville, NC 28314-1542
Phone
(910) 864-5100
NPI assigned
Jul 5, 2017
Last updated
Aug 10, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11198 NC Primary
General Practice Dentistry 1223G0001X 16247 MD

Addresses

Primary practice location

5075 Morganton Rd Ste 12
Fayetteville, NC 28314-1542

Mailing address

8218 Wisconsin Ave Ste 200
Bethesda, MD 20814-3107

Other practice location 1

8218 Wisconsin Ave Ste 200
Bethesda, MD 20814-3107
Phone (301) 654-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
16247MDMDGeneral Practice Dentistry
11198NCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Adamson & Assoc., Fayetteville, P.a. General Practice Past Accepting new patients
Bethesda Aesthetic Dentistry LLC General Practice Past Accepting new patients
DRS. Cameron & Roman I, PA General Practice Past Accepting new patients
Koyomji Dental General Practice Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786320000000",
    "number": "1053832683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8218 WISCONSIN AVE STE 200",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208143107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5075 MORGANTON RD STE 12",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141542",
            "telephone_number": "910-864-5100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8218 Wisconsin Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208143107",
            "country_code": "US",
            "telephone_number": "301-654-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOUYOUMJIAN",
        "first_name": "SANDRA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-05",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "11198",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "16247",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.