Provider Demographics
NPI:1851590152
Name:CHAMBERS, MARK AARON (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:AARON
Last Name:CHAMBERS
Suffix:
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 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124
Mailing Address - Country:US
Mailing Address - Phone:208-524-7055
Mailing Address - Fax:208-524-7209
Practice Address - Street 1:2860 VALENCIA DR STE 101
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7597
Practice Address - Country:US
Practice Address - Phone:208-524-7055
Practice Address - Fax:208-524-7209
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-40851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice