Provider Demographics
NPI:1639287881
Name:CHAMPLIN, THAD LOREN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:THAD
Middle Name:LOREN
Last Name:CHAMPLIN
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Gender:M
Credentials:DDS, MSD
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Mailing Address - Street 1:44439 NORTH 17TH ST WEST
Mailing Address - Street 2:#205
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-945-7868
Mailing Address - Fax:661-945-4488
Practice Address - Street 1:44439 NORTH 17TH ST WEST
Practice Address - Street 2:#205
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-945-7868
Practice Address - Fax:661-945-4488
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA0208321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics