Richard Alan Champany, DDS MPH
Individual provider Active NPI Dentist · Shiprock, NM
NPI 1922096643 · NPPES record last updated Sep 18, 2007
Key facts
- NPI
- 1922096643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1783 (NM)
- Practice address
- US Hwy 491 North
Shiprock, NM 87420 - Phone
- (505) 368-6401
- Fax
- (505) 368-6431
- NPI assigned
- Oct 6, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3962 | AZ | MD | Dentist |
| 1783 | NM | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1783 | NM | Yes |
| Dentist | 122300000X | 3962 | AZ |
Addresses
Primary practice location
US Hwy 491 North
Shiprock, NM 87420
Mailing address
PO Box 160
Shiprock, NM 87420-0160
Phone (505) 368-6401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31730558 | Medicaid | CO | |
| R5276 | Medicaid | NM | |
| 434910 | Medicaid | AZ |
Other providers in Shiprock, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2007. 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.