Organization
CHAMPION DENTISTRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES W CHAMPION JR. DDS (OWNER)
(215) 473-4717
Entity
Organization
Contact information
Practice address
1172 N 63RD ST, PHILADELPHIA, PA 19151-3208
(215) 473-4717
Mailing address
1172 N 63RD ST, PHILADELPHIA, PA 19151-3208
(215) 473-4717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
01/15/2021
Last updated
02/24/2021
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