Provider Demographics
NPI:1316095938
Name:CHAMPLIN ORTHODONTICS
Entity type:Organization
Organization Name:CHAMPLIN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:CHAMPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSD DDS INC
Authorized Official - Phone:661-945-7868
Mailing Address - Street 1:44439 NORTH 17TH STREET WEST
Mailing Address - Street 2:# 205
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-945-7868
Mailing Address - Fax:661-945-4488
Practice Address - Street 1:44439 NORTH 17TH STREET WEST
Practice Address - Street 2:# 205
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-945-7868
Practice Address - Fax:661-945-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty