Provider Demographics
NPI:1518535350
Name:CHAMPION SMILES PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:CHAMPION SMILES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-982-1500
Mailing Address - Street 1:125 ED SCHMIDT BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5588
Mailing Address - Country:US
Mailing Address - Phone:512-982-1500
Mailing Address - Fax:512-846-2845
Practice Address - Street 1:125 ED SCHMIDT BLVD STE 240
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5588
Practice Address - Country:US
Practice Address - Phone:512-982-1500
Practice Address - Fax:512-846-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty