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General NPI Number Information
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NPI Number | 1336353283
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Entity Type | Individual
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Provider Name | DERRICK RANIER CHAMPION D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 207 CALLE METIS
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City | DORADO
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State | PR
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Zip | 00646-4618
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Country | US
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Telephone | 787-369-7600
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Fax | 787-369-7601
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Provider Business Mailing Address
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Address Line | CARRETERA 693 KM 13.7 SUITE 201B PLAZA DEL MAR SHOPPING CENTER
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 787-369-7600
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Fax | 787-369-7601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 053036
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License Number State | NY
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