Provider Demographics
NPI:1952313447
Name:CHAMBLEE, ERICK C (DDS)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:C
Last Name:CHAMBLEE
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:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-0297
Mailing Address - Country:US
Mailing Address - Phone:330-627-5666
Mailing Address - Fax:330-627-7889
Practice Address - Street 1:1040 TRUMP ROAD
Practice Address - Street 2:ST A
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615
Practice Address - Country:US
Practice Address - Phone:330-627-5666
Practice Address - Fax:330-627-7889
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OH22304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies