Organization
CHAMPAIGN DENTAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA MICHELLE MAYSE (OFFICE MANAGER)
(937) 653-8650
Entity
Organization
Contact information
Practice address
139 PATRICK AVE, URBANA, OH 43078-2123
(937) 653-8650
(937) 653-8606
Mailing address
139 PATRICK AVE, URBANA, OH 43078-2123
(937) 653-8650
(937) 653-8606
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15524
OH
Other
Enumeration date
08/01/2006
Last updated
08/22/2020
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