Provider Demographics
NPI:1699811182
Name:CHAMBERS, MARCIE VONDRICH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:VONDRICH
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARCELA
Other - Middle Name:VONDRICH
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:862 BIG BEAR CIR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5926
Mailing Address - Country:US
Mailing Address - Phone:602-615-8600
Mailing Address - Fax:
Practice Address - Street 1:20241 N 67TH AVE STE A3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6658
Practice Address - Country:US
Practice Address - Phone:623-561-1991
Practice Address - Fax:623-561-0193
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice