Provider Demographics
NPI:1447795265
Name:CHAMBERS, MAXMILLIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAXMILLIAN
Middle Name:
Last Name:CHAMBERS
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 1:2237 FLOWERPOT LN
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1957
Mailing Address - Country:US
Mailing Address - Phone:309-846-5682
Mailing Address - Fax:
Practice Address - Street 1:3430 MARRON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4674
Practice Address - Country:US
Practice Address - Phone:760-730-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist