| Cpdg-am | |
|
7556 Teague Rd Suite 110 Hanover MD 21076-1213 | |
| (410) 799-0780 | |
| (410) 799-0781 |
| Full Name | Cpdg-am |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 7556 Teague Rd, Hanover, Maryland |
| Authorized Official Name and Position | Hakan Omer Koymen (PRESIDENT) |
| Authorized Official Contact | 4102483384 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cpdg-am 7556 Teague Rd Suite 110 Hanover MD 21076-1213 Ph: (410) 799-0780 | Cpdg-am 7556 Teague Rd Suite 110 Hanover MD 21076-1213 Ph: (410) 799-0780 |
| NPI Number | 1891043006 |
|---|---|
| Provider Enumeration Date | 08/17/2012 |
| Last Update Date | 02/06/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891043006 | NPI | - | NPPES |
| 036344800 | Medicaid | MD | |
| 022999700 | Medicaid | MD | |
| 026120300 | Medicaid | MD | |
| 9200608 | Medicaid | MD | |
| 008494860 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 12770 (Maryland) | Primary |
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