Provider Demographics
NPI:1710181094
Name:CHAMBERS, MARTIN JOSEPH JR (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOSEPH
Last Name:CHAMBERS
Suffix:JR
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 1:21990 LORAIN ROAD
Mailing Address - Street 2:#205
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126
Mailing Address - Country:US
Mailing Address - Phone:440-333-4046
Mailing Address - Fax:440-895-1183
Practice Address - Street 1:21990 LORAIN ROAD
Practice Address - Street 2:#205
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126
Practice Address - Country:US
Practice Address - Phone:440-333-4046
Practice Address - Fax:440-895-1183
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH177111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0573115Medicare ID - Type Unspecified