NPIMap

Organization Active NPI

Champagne Dental Corp

  • Dentist
  • Clearwater, FL
National Provider Identifier
1265918312
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN11998 Issued in FL
Legal business name
CHAMPAGNE DENTAL CORP
Practice address
1330 S Belcher Rd
Clearwater, FL 33764-3713
Phone
(727) 535-3233
Fax
(727) 535-1185
NPI assigned
Jul 12, 2018
Last updated
Jul 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Holly Kay
Title
Vice President
Phone
(727) 251-1907

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DN11998 FL Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DN19345 FL
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DN19494 FL

Addresses

Primary practice location

1330 S Belcher Rd
Clearwater, FL 33764-3713

Mailing address

2385 NW Executive Center Dr Ste 100
Boca Raton, FL 33431-8510
Phone (727) 251-1907

Other practice location 1

6658 1st Ave S
St Petersburg, FL 33707-1320
Phone (727) 384-6656

Other identifiers 3

IdentifierTypeStateIssuer
1649568767OtherFLCATHERINE DE LA TORRE DMD
1063545242OtherFLGEORGE HITZEL DDS
1164710976OtherFLLINDSEY REZNIK DMD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1265918312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2385 NW EXECUTIVE CENTER DR STE 100",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334318510",
            "telephone_number": "727-251-1907",
            "fax_number": "727-535-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 S BELCHER RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337643713",
            "telephone_number": "727-535-3233",
            "fax_number": "727-535-1185"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6658 1st Ave S",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337071320",
            "country_code": "US",
            "telephone_number": "727-384-6656",
            "fax_number": "727-381-8252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHAMPAGNE DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-12",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "KAY",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "727-251-1907"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN11998",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19345",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19494",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CATHERINE DE LA TORRE DMD",
            "identifier": "1649568767",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGE HITZEL DDS",
            "identifier": "1063545242",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LINDSEY REZNIK DMD",
            "identifier": "1164710976",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.