Provider Demographics
NPI:1760584809
Name:CHAMBERS, WANESSA (EFDA DENTAL ASST)
Entity Type:Individual
Prefix:MRS
First Name:WANESSA
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:EFDA DENTAL ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 NE KILLINGSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2400
Mailing Address - Country:US
Mailing Address - Phone:503-245-0304
Mailing Address - Fax:
Practice Address - Street 1:5319 NE KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2400
Practice Address - Country:US
Practice Address - Phone:503-245-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant