Provider Demographics
NPI:1316030471
Name:LAURA L. CHAMBERLAIN, DDS, PA
Entity Type:Organization
Organization Name:LAURA L. CHAMBERLAIN, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-489-5600
Mailing Address - Street 1:3608 SHANNON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6344
Mailing Address - Country:US
Mailing Address - Phone:919-489-5600
Mailing Address - Fax:919-489-2555
Practice Address - Street 1:3608 SHANNON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6344
Practice Address - Country:US
Practice Address - Phone:919-489-5600
Practice Address - Fax:919-489-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
91481OtherBLUE CROSS BLUE SHIELD ID
974731OtherUNITED CONCORDIA ID#