NPIMap

Organization Active NPI

CPDG-Am

  • Pediatric Dentistry
  • Hanover, MD
National Provider Identifier
1891043006
Registry record updated Feb 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
12770 Issued in MD
Legal business name
CPDG-AM
Practice address
7556 Teague Rd
Suite 110
Hanover, MD 21076-1213
Phone
(410) 799-0780
Fax
(410) 799-0781
NPI assigned
Aug 17, 2012
Last updated
Feb 6, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
CHESAPEAKE PEDIATRIC DENTAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2017

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

Authorized official

Name
Hakan Omer Koymen, DDS, MSNPI 1467515049
Title
President
Phone
(410) 248-3384

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 12770 MD Primary

Addresses

Primary practice location

7556 Teague Rd
Suite 110
Hanover, MD 21076-1213

Mailing address

7556 Teague Rd
Suite 110
Hanover, MD 21076-1213
Phone (410) 799-0780

Other identifiers 5

IdentifierTypeStateIssuer
036344800MedicaidMD
022999700MedicaidMD
026120300MedicaidMD
9200608MedicaidMD
008494860MedicaidMD

National Provider Directory

National Provider Directory
Part of
Chesapeake Pediatric Dental Group Inc

Locations

7556 Teague Rd
Ste 110
Hanover, MD 21076
Phone (410) 799-0780

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1891043006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7556 TEAGUE RD",
            "address_2": "SUITE 110",
            "city": "HANOVER",
            "state": "MD",
            "postal_code": "210761213",
            "telephone_number": "410-799-0780",
            "fax_number": "410-799-0781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7556 TEAGUE RD",
            "address_2": "SUITE 110",
            "city": "HANOVER",
            "state": "MD",
            "postal_code": "210761213",
            "telephone_number": "410-799-0780",
            "fax_number": "410-799-0781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CPDG-AM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHESAPEAKE PEDIATRIC DENTAL GROUP, LLC",
        "enumeration_date": "2012-08-17",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "KOYMEN",
        "authorized_official_first_name": "HAKAN",
        "authorized_official_middle_name": "OMER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-248-3384",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "12770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036344800",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022999700",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026120300",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9200608",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008494860",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanover, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; 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.