Provider Demographics
NPI:1043201270
Name:CHAMBERLAIN, JEFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 US HIGHWAY 50
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-9214
Mailing Address - Country:US
Mailing Address - Phone:530-577-8080
Mailing Address - Fax:530-577-3802
Practice Address - Street 1:3170 US HIGHWAY 50
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-9214
Practice Address - Country:US
Practice Address - Phone:530-577-8080
Practice Address - Fax:530-577-3802
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-05
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice