Provider Demographics
NPI:1154512515
Name:CHAMPION ORTHODONTICS
Entity Type:Organization
Organization Name:CHAMPION ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:SHRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-992-9190
Mailing Address - Street 1:3311 DANIELS RD
Mailing Address - Street 2:STE 104
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:407-992-9190
Mailing Address - Fax:
Practice Address - Street 1:3311 DANIELS RD
Practice Address - Street 2:STE 104
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787
Practice Address - Country:US
Practice Address - Phone:407-992-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 164461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty