| NPI | 1629615794 |
|---|---|
| Doing Business As | CHAMPAIGN DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | JENNIFER MASON Office Manager 937-653-8650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-12-07 |
| Last Update Date | 2019-12-07 |