Provider Demographics
NPI:1891709416
Name:DEBORAH CHAMPION DDS INC
Entity type:Organization
Organization Name:DEBORAH CHAMPION DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:REAMS
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-228-1212
Mailing Address - Street 1:3703 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1618
Mailing Address - Country:US
Mailing Address - Phone:419-228-1212
Mailing Address - Fax:419-228-1222
Practice Address - Street 1:3703 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1618
Practice Address - Country:US
Practice Address - Phone:419-228-1212
Practice Address - Fax:419-228-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30018203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty