# CHAMPION DENTISTRY INC

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

## Provider details

- **NPI number:** 1457940272
- **Authorized official:** CHARLES W CHAMPION JR. DDS (OWNER)
- **Authorized official phone:** (215) 473-4717

## Contact information

- **Practice address:** 1172 N 63RD ST, PHILADELPHIA, PA 19151-3208
- **Practice address phone:** (215) 473-4717
- **Mailing address:** 1172 N 63RD ST, PHILADELPHIA, PA 19151-3208
- **Mailing address phone:** (215) 473-4717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 01/15/2021
- **Last updated:** 02/24/2021