Provider Demographics
NPI:1740200344
Name:CHUCK CHAMBERS DMD
Entity Type:Organization
Organization Name:CHUCK CHAMBERS DMD
Other - Org Name:MOBLEY AND CHAMBERS DENTAL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-338-8962
Mailing Address - Street 1:2105 ELDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-3356
Mailing Address - Country:US
Mailing Address - Phone:706-338-8962
Mailing Address - Fax:
Practice Address - Street 1:2105 ELDER MILL RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-3356
Practice Address - Country:US
Practice Address - Phone:706-338-8962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-05-09
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-21
Provider Licenses
StateLicense IDTaxonomies
GA12005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty