Provider Demographics
NPI:1629285879
Name:CHAMBERLAIN, CRAIG ALLEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLEN
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CAJON ST STE D
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5216
Mailing Address - Country:US
Mailing Address - Phone:909-793-2791
Mailing Address - Fax:909-793-9701
Practice Address - Street 1:232 CAJON ST STE D
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5216
Practice Address - Country:US
Practice Address - Phone:909-793-2791
Practice Address - Fax:909-793-9701
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics