Provider Demographics
NPI:1679630321
Name:CHAMBERLAIN, DARREN D (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:D
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 W. 400 S.
Mailing Address - Street 2:STE 101
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663
Mailing Address - Country:US
Mailing Address - Phone:801-489-1301
Mailing Address - Fax:801-491-4851
Practice Address - Street 1:688 W. 400 S.
Practice Address - Street 2:STE 101
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663
Practice Address - Country:US
Practice Address - Phone:801-489-1301
Practice Address - Fax:801-491-4851
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5672895-99231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT582779657001Medicaid