Organization
GD FL CHAMPAGNE PLLC
Active
Other names
Champagne Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
6658 1ST AVE S, ST PETERSBURG, FL 33707-1320
(727) 384-6656
Mailing address
6658 1ST AVE S, ST PETERSBURG, FL 33707-1320
(727) 384-6656
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/18/2024
Last updated
11/18/2024
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