Derrick Ranier Champion, D.D.S.
Individual provider Active NPI Dentist · Dorado, PR
NPI 1336353283 · NPPES record last updated Nov 23, 2015
Key facts
- NPI
- 1336353283
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 053036 (NY)
- Practice address
- 207 Calle Metis
Dorado, PR 00646-4618 - Phone
- (787) 369-7600
- Fax
- (787) 369-7601
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 053036 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lebanon Dental Group | Current | Accepting new patients | |
| Champion Dentistry, LLC | Current | Accepting new patients | |
| Champion Dental PC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 053036 | NY | Yes |
Addresses
Primary practice location
207 Calle Metis
Dorado, PR 00646-4618
Mailing address
Carretera 693 KM 13.7 Suite 201B
Plaza del Mar Shopping Center
Vega Alta, PR 00692
Phone (787) 369-7600
Other providers in Dorado, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.