Provider Demographics
NPI:1043893175
Name:CHAMBERLAIN DENTAL
Entity Type:Organization
Organization Name:CHAMBERLAIN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-441-6060
Mailing Address - Street 1:555 S HERCULES AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6347
Mailing Address - Country:US
Mailing Address - Phone:727-441-6060
Mailing Address - Fax:727-614-9904
Practice Address - Street 1:555 S HERCULES AVE STE 403
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6347
Practice Address - Country:US
Practice Address - Phone:727-441-6060
Practice Address - Fax:727-614-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty