MEDICARE: DR. ALLEN F. CHAMPION DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS037106	PA
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DS037106	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245215508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN F. CHAMPION DDS

Provider Business Mailing Address
First Line	:	909 WALNUT STREET
Second Line	:	300 COB
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5211
Country	:	US
Telephone Number	:	215-955-6215
Fax Number	:	215-923-9189

Provider Business Practice Location Address
First Line	:	909 WALNUT STREET
Second Line	:	300 COB
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5211
Country	:	US
Telephone Number	:	215-955-6215
Fax Number	:	215-923-9189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	08/23/2019

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