Provider Demographics
NPI:1770026841
Name:CORY CHAMBERS
Entity Type:Organization
Organization Name:CORY CHAMBERS
Other - Org Name:COBBLESTONE PARK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-603-8520
Mailing Address - Street 1:12321 N. COUNCIL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162
Mailing Address - Country:US
Mailing Address - Phone:405-603-8520
Mailing Address - Fax:405-603-8560
Practice Address - Street 1:12321 N. COUNCIL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162
Practice Address - Country:US
Practice Address - Phone:405-603-8520
Practice Address - Fax:405-603-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1063617546OtherNPPES