GD FL Champagne PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GD FL CHAMPAGNE PLLC

Doing business as

Champagne Dental

Practice address

6658 1St Ave S
St Petersburg, FL 33707-1320

Phone

(727) 384-6656

NPI assigned

Nov 18, 2024

Last updated

Nov 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chad Hendricks

Title

Credentialing

Phone

(612) 859-0444

Specialties & licenses 1

Addresses

Other names 1

• Champagne Dental Doing business as

Locations

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.

• George Edward Hitzel, DDS

  • General Practice Dentistry
  • St Petersburg, FL
  • NPI 1063545242
  NPD (past)

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1639994353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6658 1ST AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337071320",
            "telephone_number": "727-384-6656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6658 1ST AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337071320",
            "telephone_number": "727-384-6656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 S Belcher Rd",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337643713",
            "country_code": "US",
            "telephone_number": "727-263-4197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GD FL CHAMPAGNE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "612-859-0444"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Champagne Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Betty J Gathers, CCCE, CLD, CTSP
• Carolyn Marie Gaulden, MD, MBA, MSW
• Rachel Ann Gavin, PHARMD
• Bryan Gayne, D.O.
• Antonio J Gayoso, M.D.
• Luis Rene Geada, M.D.
• Amanda Geary, O.D.
• Sara L Gedajlovic, LMHC
• Jennifer Opalek Geddes, F.N.P. - C
• Sean Gehring

• General Practice Dentistry in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.