Provider Demographics
NPI:1376575613
Name:CHAMBERLAIN, D CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:D
Middle Name:CRAIG
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:PO BOX 625
Mailing Address - Street 2:399 ARIA BLVD
Mailing Address - City:WENDOVER
Mailing Address - State:UT
Mailing Address - Zip Code:84083-0625
Mailing Address - Country:US
Mailing Address - Phone:435-665-2962
Mailing Address - Fax:435-665-7525
Practice Address - Street 1:399 N ARIA BLVD
Practice Address - Street 2:
Practice Address - City:WENDOVER
Practice Address - State:UT
Practice Address - Zip Code:84083-0625
Practice Address - Country:US
Practice Address - Phone:435-665-2962
Practice Address - Fax:435-665-7525
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist