Organization
CHAMPION DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK CHAMPION D.D.S. (DENTIST/OWNER)
(787) 369-7600
Entity
Organization
Contact information
Practice address
CARRETERA 693 KM 13.7, PLAZA DEL MAR SOPPING C SUITE 201B, VEGA ALTA, PR 00646
(787) 369-7600
Mailing address
207 CALLE METIS, DORADO, PR 00646-4618
(787) 369-7600
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3179
PR
Other
Enumeration date
01/15/2016
Last updated
01/15/2016
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