Provider Demographics
NPI:1366629677
Name:CHAMBERS, JACK RONALD II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:RONALD
Last Name:CHAMBERS
Suffix:II
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:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438
Mailing Address - Country:US
Mailing Address - Phone:304-725-7044
Mailing Address - Fax:304-724-5299
Practice Address - Street 1:201 AUGUSTINE AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414
Practice Address - Country:US
Practice Address - Phone:304-725-7044
Practice Address - Fax:304-724-5299
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice