Provider Demographics
NPI:1508184128
Name:CHAMBERLAIN, THEODORE KERRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:KERRY
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIN PROGRESS122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist