# CHAMPION DENTISTRY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053946525
- **Authorized official:** DR. DERRICK CHAMPION DDS (OWNER)
- **Authorized official phone:** (615) 554-7401

## Contact information

- **Practice address:** 322 N MAPLE ST, LEBANON, TN 37087-2706
- **Practice address phone:** (615) 606-2544
- **Practice address fax:** (888) 752-1480
- **Mailing address:** 322 N MAPLE ST, LEBANON, TN 37087-2706
- **Mailing address phone:** (615) 606-2544
- **Mailing address fax:** (888) 752-1480

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/05/2020
- **Last updated:** 03/05/2020