Individual
DR. JEFFREY LEE CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
129 N MADISON STREET, WAUPUN, WI 53963-0188
(920) 324-2561
(920) 324-2561
Mailing address
PO BOX 188, 129 N MADISON STREET, WAUPUN, WI 53963-0188
(920) 324-2561
(920) 324-2561
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3743
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33721600
MEDICAL ASSISTANCE
WI
Enumeration date
03/26/2007
Last updated
07/08/2007
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