Organization
CHAMPAGNE DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY KAY (VICE PRESIDENT)
(727) 251-1907
Entity
Organization
Contact information
Practice address
1330 S BELCHER RD, CLEARWATER, FL 33764-3713
(727) 535-3233
(727) 535-1185
Mailing address
2385 NW EXECUTIVE CENTER DR STE 100, BOCA RATON, FL 33431-8510
(727) 251-1907
(727) 535-1185
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN11998
FL
122300000X
Dentist
DN19345
FL
122300000X
Dentist
DN19494
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063545242
GEORGE HITZEL DDS
FL
01
—
1164710976
LINDSEY REZNIK DMD
FL
01
—
1649568767
CATHERINE DE LA TORRE DMD
FL
Enumeration date
07/12/2018
Last updated
07/12/2018
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