Implant Dentistry of Venice LLC

Primary specialty

DentistTaxonomy code 122300000X

License

6743 Issued in FL

Legal business name

IMPLANT DENTISTRY OF VENICE LLC

Practice address

1515 Tamiami Trail S
Suite 3
Venice, FL 34285

Phone

(941) 497-1585

Fax

(941) 496-7905

NPI assigned

Oct 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. David M Champion

Title

President

Phone

(941) 497-1585

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871681692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 TAMIAMI TRAIL S",
            "address_2": "SUITE 3",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "34285",
            "telephone_number": "941-497-1585",
            "fax_number": "941-496-7905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 TAMIAMI TRAIL S",
            "address_2": "SUITE 3",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "34285",
            "telephone_number": "941-497-1585",
            "fax_number": "941-496-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPLANT DENTISTRY OF VENICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHAMPION",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-497-1585",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "6743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Venice, FL
• Providers in Venice, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.