Provider Demographics
NPI:1164993259
Name:RICHARD CHAMPAGNE DMD PC
Entity Type:Organization
Organization Name:RICHARD CHAMPAGNE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINHATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PALASCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-972-0918
Mailing Address - Street 1:480 ROUTE 79
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4090
Mailing Address - Country:US
Mailing Address - Phone:732-972-0918
Mailing Address - Fax:732-972-0044
Practice Address - Street 1:480 ROUTE 79
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4090
Practice Address - Country:US
Practice Address - Phone:732-972-0918
Practice Address - Fax:732-972-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty