Provider Demographics
NPI:1801000369
Name:CHAMBERS ROAD DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:CHAMBERS ROAD DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-366-1592
Mailing Address - Street 1:13701 E MISSISSIPPI AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6142
Mailing Address - Country:US
Mailing Address - Phone:303-366-1592
Mailing Address - Fax:303-366-1812
Practice Address - Street 1:13701 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6141
Practice Address - Country:US
Practice Address - Phone:303-366-1592
Practice Address - Fax:303-366-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO55551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty