Provider Demographics
NPI:1538200449
Name:CHAMPSI, MUKHTTAR JAFFER (DDS, DC)
Entity type:Individual
Prefix:DR
First Name:MUKHTTAR
Middle Name:JAFFER
Last Name:CHAMPSI
Suffix:
Gender:M
Credentials:DDS, DC
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:J
Other - Last Name:CHAMPSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, DC
Mailing Address - Street 1:1304 VILLAGE CREEK DR
Mailing Address - Street 2:#400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4449
Mailing Address - Country:US
Mailing Address - Phone:972-733-3666
Mailing Address - Fax:
Practice Address - Street 1:1304 VILLAGE CREEK DR
Practice Address - Street 2:#400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4449
Practice Address - Country:US
Practice Address - Phone:972-733-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6973111N00000X
TX191011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered1223G0001XDental ProvidersDentistGeneral Practice